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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364815463
Report Date: 08/18/2023
Date Signed: 08/18/2023 10:37:26 AM


Document Has Been Signed on 08/18/2023 10:37 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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501



FACILITY NAME:JOHNSON & GENTLE FAMILY CHILD CAREFACILITY NUMBER:
364815463
ADMINISTRATOR:JOHNSON, JR., GARYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 864-0773
CITY:HIGHLANDSTATE: CAZIP CODE:
92346
CAPACITY:14CENSUS: 1DATE:
08/18/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Tanya GentleTIME COMPLETED:
10:40 AM
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On 08/18/2023 at time listed above Licensing Program Analyst (LPA) Justin Giese made an unannounced visit to the facility for the purpose of proof of corrections for deficiencies cited on 07/18/2023 . LPA met with Licensee, Tanya Gentle and was granted access to the facility.

At time of visit LPA observed 1 child in care. As part of this visit, LPA toured the facility inside/out and reviewed documents/children's records.

The following deficiencies were cleared at time of visit:
1. Accessible knives and cleaning compounds in kitchen
2. Verification of disaster drill
3. Licensee Mandated Reporter Renewal
4. Licensee CPR renewal
5. Verification of LIC9227 forms for infants in care
6. Verification of 15 minute sleep checks for infants in care


Exit interview conducted and report was reviewed with Licensee, Tanya Gentle.

A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Justin GieseTELEPHONE: (951) 204-4847
LICENSING EVALUATOR SIGNATURE:
DATE: 08/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/18/2023
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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