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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393614483
Report Date: 08/30/2024
Date Signed: 08/30/2024 10:45:10 AM


Document Has Been Signed on 08/30/2024 10:45 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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:MONTOYA, VANESAFACILITY NUMBER:
393614483
ADMINISTRATOR:MONTOYA, VANESAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 951-3448
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY:14CENSUS: 6DATE:
08/30/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Vanesa MontoyaTIME COMPLETED:
11:00 AM
NARRATIVE
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On 08/30/24, Licensing Program Analyst (LPA) Elvira Sierra conducted a Case Management inspection and met with Licensee, Vanesa Montoya. Upon arrival present in the facility was Licensee caring for 6 children. Licensee's assistant arrived later during the inspection.

The purpose of the inspection was to discuss an unusual incident that occurred on 08/21/24; which was not reported to the department by the facility. LPA discussed reporting requirements with Licensee.

Deficiency cited on subsequent page 809D. Exit interview conducted. This report and Appeal of Rights were reviewed and provided to Licensee, Vanesa Montoya. Notice of Site Visit posted.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira SierraTELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:
DATE: 08/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/30/2024
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 2


Document Has Been Signed on 08/30/2024 10:45 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827


FACILITY NAME: MONTOYA, VANESA
FACILITY NUMBER: 393614483

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/30/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/06/2024
Section Cited
CCR
102416.2(b)(2)

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102416.2(b)(2) Reporting Requirements
(b) The licensee shall report to the Department any of the events as specified in Health and Safety Code....that occur during the operation of the family child care home.
(2)Any child absence means any instance where a child in care is missing. For example, any child in care who wanders away from the Family Child Care Home,
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POC: Licensee stated that she will submit a written iincident report by poc due date.
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.......shall be reported even if the child is later found safe. This requirement was not met as evidence by; During today’s visit Licensee confirmed that on 08/21/24 child#1 was found alone in the neighbor’s front yard. Licensee stated that Child#1 was returned by a neighbor within 20 seconds. This is a deficiency that if not corrected can poses a risk to health and safety of the children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira SierraTELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:
DATE: 08/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/30/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2