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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343606947
Report Date: 02/05/2025
Date Signed: 02/05/2025 01:26:32 PM

Document Has Been Signed on 02/05/2025 01:26 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 CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:HIRAM JOHNSON CENTERFACILITY NUMBER:
343606947
ADMINISTRATOR/
DIRECTOR:
SARABA/VANG, YEFACILITY TYPE:
850
ADDRESS:3535 65TH STREETTELEPHONE:
(916) 395-5511
CITY:SACRAMENTOSTATE: CAZIP CODE:
95820
CAPACITY: 73TOTAL ENROLLED CHILDREN: 73CENSUS: 18DATE:
02/05/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:45 AM
MET WITH:Dometila CasillasTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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Licensing Program Analysts (LPAs) Julia Maryanova and Stephanie Piring met with Teacher Dometila Casillas for an unannounced case management inspection regarding a self reported incident which occurred on 01/23/2025. Upon arrival LPAs observed care and supervision of 18 napping children supervised by 3 staff.

It was reported that on 01/23/25, a child was hit by a teacher on the bottom over making a mess. This was reported to Dr. Angélle Carson who is the Coordinator that oversee that site by the child's parent. The center conducted their own investigation where they interviewed all staff present on the date of incident before reporting UIR to Licensing.

LPAs conducted interviews with the teacher and staff #1 who were present that day. LPAs learned that there was nothing unusual which took place on 01/23/25. Both parties confirmed the child follows instructions, plays well with other children and doesn't have any negative behavior, and confirmed that the child has not returned to care since the date of reported incident. Both staff stated that the staff is never left alone with the children.

Based on todays visit, LPAs concluded that no Title 22 regulations were violated. Exit interview conducted and report was reviewed with Facility Representative Dometila Casillas. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Julia Maryanova
LICENSING EVALUATOR SIGNATURE: DATE: 02/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/05/2025
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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