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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423870
Report Date: 09/06/2023
Date Signed: 09/06/2023 09:51:50 AM

Document Has Been Signed on 09/06/2023 09:51 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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:JOHNSON, LATRICE & SHEFFIELD-JOHNSON, GABRIELLEFACILITY NUMBER:
013423870
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 2CENSUS: 2DATE:
09/06/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Johnson, Latrice & Sheffield-Johnson, GabrielleTIME COMPLETED:
10:30 AM
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On 09/06/2023 at 9:00AM Licensing Program Analysts (LPAs), A. Curry and S. Blue conducted an announced case management inspection to add the kitchen and living room as an on-limit area. LPAs met with the licensees Latrice Johnson & Gabrielle Sheffield, to explain the purpose of today's visit. LPAs toured the facility and made observations. There were no compliance issues during this visit. The kitchen and living room will be on-limit effective today 09/06/2023.

Exit interview conducted, appeal rights were given, and report was reviewed with the licensees Latrice Johnson & Gabrielle Sheffield.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Ashley Curry
LICENSING EVALUATOR SIGNATURE: DATE: 09/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/06/2023
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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