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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393622804
Report Date: 04/06/2023
Date Signed: 04/06/2023 02:06:32 PM


Document Has Been Signed on 04/06/2023 02:06 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833



FACILITY NAME:STOREY, MONICAFACILITY NUMBER:
393622804
ADMINISTRATOR:GUARDADO, MONICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 227-8323
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY:14CENSUS: 4DATE:
04/06/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Monica StoreyTIME COMPLETED:
02:25 PM
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On 04/06/23 Licensing Program Analyst (LPA) Elvira Sierra met with Licensee, Monica Storey for a Plan of Correction (POC) inspection. A follow up evaluation was conducted on today inspection to verify compliance for type A citation cited on 03/01/23. LPA observed Licensee caring for 4 children. Facility is within License capacity during visit.

LPA observed a pack and play by the sitting area that is in compliance with safe sleep guidelines. Type A deficiency was cleared on today's inspection.

This report and Appeal of Rights were reviewed and provided to Licensee, Monica Storey. A Notice of Site of Site visit was posted and exit interview conducted.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira SierraTELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:
DATE: 04/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/06/2023
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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