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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393622804
Report Date: 03/16/2023
Date Signed: 03/16/2023 01:13:54 PM


Document Has Been Signed on 03/16/2023 01:13 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: 7DATE:
03/16/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Monica StoreyTIME COMPLETED:
01:30 PM
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
On 03/16/22 Licensing Program Analyst (LPA) Elvira Sierra met with Licensee, Monica for an unannounced case management inspection to clear a Type A deficiency cited on March 01, 2023. LPA observed Licensee caring for 7 children (one infant, 5 preschool, and one school age)

LPA did not observed any crib for infant in care. For this reason, LPA could not clear the plan of correction on today's date. LPA assessed a civil penalty for failure to correct the plan of correction.

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: 03/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/16/2023
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