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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343601779
Report Date: 11/13/2023
Date Signed: 11/13/2023 01:46:41 PM


Document Has Been Signed on 11/13/2023 01:46 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:SETA - HILLSDALE AVENUE HEAD STARTFACILITY NUMBER:
343601779
ADMINISTRATOR:DAVID HUGHESFACILITY TYPE:
850
ADDRESS:5665 HILLSDALE BLVD.TELEPHONE:
(916) 263-1031
CITY:NORTH HIGHLANDSSTATE: CAZIP CODE:
95842
CAPACITY:80CENSUS: 42DATE:
11/13/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:David HughesTIME COMPLETED:
02:15 PM
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On November 13, 2023, Licensing Program Analyst (LPA) Amanda Sutter met with Director David Hughes for a case management inspection to discuss the unusual incident report (UIR) that was reported and submitted on November 3, 2023. Forty-two children were present at the facility..

LPA made observations and conducted interviews.

No deficiencies were cited in today’s visit.

Exit interview was conducted with David Hughes and notice of site visit was posted.
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Amanda SutterTELEPHONE: (916) 261-8918
LICENSING EVALUATOR SIGNATURE:
DATE: 11/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/13/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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