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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393615490
Report Date: 03/04/2025
Date Signed: 03/04/2025 10:18:30 AM

Document Has Been Signed on 03/04/2025 10:18 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:WASHINGTON, KIMBERLYFACILITY NUMBER:
393615490
ADMINISTRATOR/
DIRECTOR:		WASHINGTON, KIMBERLYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 951-9302
CITY:STOCKTONSTATE: CAZIP CODE:
95212
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
03/04/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Licensee, Kimberly WashingtonTIME VISIT/
INSPECTION COMPLETED:
10:35 AM
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On 03/04/2025, Licensing Program Analyst (LPA) Elizabeth Santiago conducted an unannounced case management inspection and met with licensee, Kimberly Washington. The purpose of the inspection is to verify that the required removal of the individual not cleared to work at the facility. LPA has confirmed Jasmyne Smart does not live at the home, has been removed and is not working at the facility.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA Santiago toured the facility inside and out. Based on evidence obtained during today's inspection, the LPA has verified that the individual is not present, employed, or residing at the facility. LPA has advised the licensee to disassociate the individual from their roster and submit an updated LIC 500.

Exit interview conducted and report was reviewed with the licensee, Kimberly Washington 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 the inspection. Verification of removal is complete.
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Elizabeth Santiago
LICENSING EVALUATOR SIGNATURE: DATE: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/04/2025
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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