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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393606420
Report Date: 07/11/2023
Date Signed: 07/11/2023 10:34:15 AM

Document Has Been Signed on 07/11/2023 10:34 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:GRIFFIN, DEBRAFACILITY NUMBER:
393606420
ADMINISTRATOR:GRIFFIN, DEBRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 943-2075
CITY:STOCKTONSTATE: CAZIP CODE:
95206
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 1DATE:
07/11/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Licensee Debra GriffinTIME COMPLETED:
10:50 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 7/11/23, Licensing program Analyst (LPA) Carla Polanco conducted an unannounced case
management visit and met with Licensee, Debra Griffin. LPA was granted entry by Licensee. Today's inspection was for the purpose of converting the off-limit backyard in the FCCH back to on-limit areas.

During today's visit there was one child present.

During the inspection, LPA observed that defected playground equipment was removed. As of today the backyard is on limit and will be included as part of the FCCH. LPA will update the License and send to Licensee. There is a play structure in the backyard, Licensee is aware that she must maintain supervision when structure is in use. The age requirements were discussed. Licensee understands that if age limit is displayed, children under the structure age limits are not allowed on the structure for their safety.

Exit interview conducted and report was reviewed with the licensee. A notice of site visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

In the areas that were evaluated, no deficiencies were cited during today’s inspection.
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Carla Polanco Rivera
LICENSING EVALUATOR SIGNATURE: DATE: 07/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/11/2023
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