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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624827
Report Date: 03/14/2024
Date Signed: 03/14/2024 01:59:04 PM

Document Has Been Signed on 03/14/2024 01:59 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:DEBORA JOHNSONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 619-6016
CITY:SACRAMENTOSTATE: CAZIP CODE:
95835
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
03/14/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Debora JohnsonTIME COMPLETED:
02:05 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
At 1:30pm on 3/14/2024, Licensing Program Analyst (LPA) Matthew Gallo met with licensee Debora Johnson for the purpose of a plan of correction visit. Today's census included 0 children.

Facility was previously cited a Type A deficiency on 3/5/2024 for the presence of a loose blanket in a pack and play containing a sleeping infant. The plan of correction dictated that licensee will move the 20 month old infant to a nap mat and that the LPA would conduct a return visit to ensure compliance. During today's visit, licensee told LPA that they had gotten rid of the pack and plays and that the 20 month old now sleeps on a nap mat. LPA observed the new sleep mat for the infant and that the pack and plays were absent from the facility. The facility is in compliance with the plan of correction.

The plan of correction for the deficiency cited on 3/5/2024 has been cleared.

Exit interview conducted and report reviewed with licensee Debora Johnson. A notice of site visit was provided and must remain posted for 30 days.

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Matthew Gallo
LICENSING EVALUATOR SIGNATURE: DATE: 03/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2024
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