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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 344500398
Report Date: 11/16/2023
Date Signed: 11/16/2023 10:19:19 AM

Document Has Been Signed on 11/16/2023 10:19 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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:GOLDEN, STEPHANIEFACILITY NUMBER:
344500398
ADMINISTRATOR:STEPHANIE GOLDENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 200-7570
CITY:GALTSTATE: CAZIP CODE:
95632
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
11/16/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Stephanie GoldenTIME COMPLETED:
10:30 AM
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 11/16/2023, Licensing Program Analyst Katy Velazquez (LPA) conducted a field visit to the facility for the purpose of a case management inspection regarding a self reported Unusual Incident Report (UIR) dated 11/09/2023.The UIR documented an incident which occurred after hours and not at the Family Childcare Home (FCCH), but involved a resident of the FCCH. LPA arrived at the FCCH and was met by Licensee Stephanie Golden (L1). LPA disclosed the purpose of the inspection and was granted entrance into the FCCH. LPA toured the FCCH and observed 7 preschool aged children and 1 infant being supervised by L1 and 2 adult aides. Also present in the FCCH was L1's minor child and spouse. LPA determined through accessing Guardian that all required adults were background cleared and associated to the license.

No deficiencies were cited in the area that were evaluated during todays inspection on 11/16/2023. An exit interview was conducted, and the report was reviewed with L1. LPA provided L1 with Licensee Appeal Rights. A Notice of Site visit was posted by LPA and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Katy Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2023
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