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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
073400254
Report Date:
03/07/2023
Date Signed:
03/07/2023 11:45:37 AM
Document Has Been Signed on
03/07/2023 11:45 AM
- 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:
9
DATE:
03/07/2023
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
10:00 AM
MET WITH:
Ligia Ortiz
TIME COMPLETED:
11:45 AM
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On 3/7/23 at 10:00 AM 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 Ligia Ortiz.
The purpose of today's visit is to amend report for the Case Management visit on 12/21/22 for an Incident Report that was reported on 10/12/22.
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 Ligia Ortiz.
SUPERVISORS NAME
:
Sherelle Johnson
LICENSING EVALUATOR NAME
:
Michelle Sutton
LICENSING EVALUATOR SIGNATURE
:
DATE:
03/07/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
03/07/2023
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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