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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
073400254
Report Date:
12/21/2022
Date Signed:
12/21/2022 02:29:01 PM
Document Has Been Signed on
12/21/2022 02:29 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
CCLD Regional Office
,
1515 CLAY STREET, SUITE 1102
OAKLAND
,
CA
94612
FACILITY NAME:
CONTRA COSTA CO. HEAD START - LAVONIA ALLEN CENTER
FACILITY NUMBER:
073400254
ADMINISTRATOR:
DORIS STEPHENS
FACILITY TYPE:
850
ADDRESS:
94 1/2 MEDANOS AVENUE
TELEPHONE:
(925) 427-8270
CITY:
BAY POINT
STATE:
CA
ZIP CODE:
94565
CAPACITY:
48
TOTAL ENROLLED CHILDREN:
15
CENSUS:
6
DATE:
12/21/2022
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
01:40 PM
MET WITH:
Averyl De Vera.
TIME COMPLETED:
02:30 PM
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On 12/21/22 at 1:40 PM Licensing Program Analyst (LPA) Michelle Sutton conducted an unannounced case management visit at Contra Costa CO. Head Start-Lavonia Allen Center. LPA met with site supervisor Averyl De Vera.
The purpose of today's visit is to amend report for the Case Management visit on 10/19/22 for an Incident Report.
A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Site Supervisor Averyl De Vera.
SUPERVISORS NAME
:
Sherelle Johnson
LICENSING EVALUATOR NAME
:
Michelle Sutton
LICENSING EVALUATOR SIGNATURE
:
DATE:
12/21/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/21/2022
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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