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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393609442
Report Date: 05/25/2023
Date Signed: 05/25/2023 11:51:17 AM

Document Has Been Signed on 05/25/2023 11:51 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:BROWN, GERMAINEFACILITY NUMBER:
393609442
ADMINISTRATOR:BROWN, GERMAINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 271-3016
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY: 14TOTAL ENROLLED CHILDREN: 9CENSUS: 2DATE:
05/25/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Germaine BrownTIME COMPLETED:
12:00 PM
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On 05/25/23, Licensing Program Analyst (LPA) Elvira Sierra met with Licensee, Germaine Brown for a plan of correction (POC) inspection. The purpose of the visit was to verify corrections for type B deficiencies cited on 04/27/23. Present in the facility was the Licensee caring for two children.

LPA conducted a tour of the facility and observed that the fence in the backyard has been repair and the spa cover lock has been replaced and is in good working condition. LPA advised Licensee to make sure backyard is free of any hazards before children are using the backyard. The facility is in complying today.

This report and Appeal of Rights were reviewed and provided to the Licensee, Germaine Brown. Exit interview conducted and Notice of Site Visit was posted.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE: DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/25/2023
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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