<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374845333
Report Date: 07/01/2021
Date Signed: 07/01/2021 10:14:43 AM

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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:JOHNSON-HUNTER FAMILY CHILD CAREFACILITY NUMBER:
374845333
ADMINISTRATOR:JOHNSON, T. & HUNTER, A.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 429-0065
CITY:OCEANSIDESTATE: CAZIP CODE:
92057
CAPACITY:14CENSUS: DATE:
07/01/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Tiphanie HunterTIME COMPLETED:
10:20 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts (LPAs) James Wilkerson and Joanne Domingo arrived at this facility to follow-up on a Unusual Incident Report (UIR). The UIR is in regards to a leak caused by the dishwasher in the kitchen. The facility closed on Friday, June 19 due to the leak. There is a remodeling happening in the kitchen during this time and workers are designated a certain entrance/exit separate from children in care. The remodeling is 99 percent completed per the contractor who is present during this visit. LPA took photos of the remodel and Ms. Johnson will submit "after" photos upon completion.

An exit interview was conducted and a copy of this report was provided to Ms. Johnson on this date.

A copy of this report must be made available to the public, upon request for three years.
SUPERVISOR'S NAME: Dawn ParkerTELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: James WilkersonTELEPHONE: (951) 218-7031
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1