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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393614483
Report Date: 09/05/2024
Date Signed: 09/05/2024 02:09:12 PM


Document Has Been Signed on 09/05/2024 02:09 PM - 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: 7DATE:
09/05/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Vanesa MontoyaTIME COMPLETED:
02:30 PM
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On 09/05/24, Licensing Program Analyst (LPAs) Elvira Sierra met with licensee, Vanesa Montoya for a plan of correction inspection. Present in the facility is Licensee and Licensee's assistant caring fro 7 children.

A follow up evaluation was conducted on today inspection to verify correction for deficiencies cited on 08/30/24. LPA received Unusual Incident Report (UIR) on 09/02/24 and also facility fenced was observed in good repair on today's visit. LPA observed that a new gate was installed to the fence located to the left side yard. LPA inspected the door and a a self locking gate latch was installed to avoid future incidents.
Corrections are noted on the Cleared POC form attached to this report. Deficiencies CCR 102417 (a)b and 102416.2(b)(2) previously cited are clear and corrected on today's inspection.

This report and Appeal of Rights were reviewed and provided to the Licensee, Vanesa Montoya. Exit interview conducted and Notice of Site Visit was posted
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira SierraTELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:
DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/05/2024
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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