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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700083
Report Date: 02/04/2021
Date Signed: 02/04/2021 01:39:57 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:JOHNSON FAMILY CHILD CAREFACILITY NUMBER:
367700083
ADMINISTRATOR:JOHNSON, TAMMYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 810-0839
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92307
CAPACITY:14CENSUS: 2DATE:
02/04/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Tammy Johnson LicenseeTIME COMPLETED:
02:02 PM
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Licensing Program Analyst (LPA) Steven Montoya virtually met with licensee Tammy Johnson The purpose of the inspection was to conduct an inspection of the pool self latching gate. Licensee will provided photo of the fencing.

Licensee is license to provide care and supervision for a Large Family Child Care for the capacity of (14) children. There are currently (2) children enrolled in the family child care.

LPA virtually inspected the pool which appears to be like a Summer Waves Elite 18ft x 48in Above Ground Frame Pool Set with Pump. The fencing appeared to be a chain link, 6 feet in height around the entire pool. At this time, the pool has no water which was recently damaged during extreme weather conditions.

Before adding water, license was advised to contact Regional Office to inspect the backyard fencing in person for safety. LPA virtually toured backyard area which is made accessible to children. Family child care home appears to ensure home is incompliance with Community Care Licensing: Title 22 Regulations. LPA will provide licensee with pool regulation via email to ensure compliance
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Steven MontoyaTELEPHONE: (661) 568-8932
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2021
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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