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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624827
Report Date: 09/19/2023
Date Signed: 09/19/2023 12:46:00 PM

Document Has Been Signed on 09/19/2023 12:46 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:JOHNSON, DEBORAFACILITY NUMBER:
343624827
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
09/19/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Debora JohnsonTIME COMPLETED:
01:20 PM
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On Tuesday, September 19, 2023 at 12:15 PM, Licensing Program Analyst (LPA) Tanya Washington met with Licensee Debora Johnson for an unannounced case management inspection to increase capacity to the maximum number of 14 children. Licensee has sufficient experience to operate a large license. During today's inspection LPA observed care and supervision of three preschool aged children. All adults residing in the home have obtained the required fingerprint clearances. Facility hours and days of operation are Monday-Friday from 6 AM to 6 PM.

Licensee rents the home and control of property has been previously verified. Licensee stated that she has verbally informed the landlord of proving care to children. Licensee is aware that prior to accepting 13th and 14th child, form LIC9149 must be signed by the landlord.
LPA discussed capacity options with and without an assistant and when the Licensee or the assistant are alone they divert to small license ratio requirements.

On September 18, 2023, Sacramento City Fire Department granted a fire clearance with no restrictions.

The off limit areas in the home are: entire second floor, laundry room, garage and backyard. There are no bodies of water on the premises. Per licensee, there are no weapons on the premises. Infant safe sleep guidelines were discussed.

Licensee's CPR and First Aid is valid until 02/2025.

EFFECTIVE TODAY, 09/19/2023 THE FACILITY IS LICENSED TO SERVE A MAX. CAP OF 12 (WHEN THERE IS AN ASSISTANT PRESENT): WITH NO MORE THAN 4 INFANTS.
OR MAX CAP 14 - NO MORE THAN 3 INFANTS. 1 CHILD IN KINDERGARTEN OR ELEMENTARY SCHOOL AND 1 CHILD AT LEAST AGE 6. Notice of site visit posted and appeal rights were provided.
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE: DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/19/2023
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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