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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343619004
Report Date: 12/20/2019
Date Signed: 12/20/2019 12:55:02 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:DOSS, TONITAFACILITY NUMBER:
343619004
ADMINISTRATOR:DOSS, TONITAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 333-4332
CITY:SACRAMENTOSTATE: CAZIP CODE:
95838
CAPACITY:14CENSUS: 4DATE:
12/20/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Tonita DossTIME COMPLETED:
01:15 PM
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Licensing Program Analysts (LPAs), Goodell met with licensee Tonita Doss for an unannounced inspection to clear deficiencies cited on 10/23/19. During inspection LPA observed 4 children with with licensee.

On 10/23/19, facility was cited for Child's Records due to LPA observed at least 4 incomplete children files which posed a potential risk to children in care. During today's inspection LPA reviewed children files and observed files complete. Therefore, deficiency cleared.

No deficiencies cited. Report was reviewed with licensee and copy provided. Notice of Site Visit was issued which must remain posted for 30 days.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Kristal GoodellTELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2019
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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