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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393622804
Report Date: 02/05/2025
Date Signed: 02/05/2025 12:07:08 PM

Document Has Been Signed on 02/05/2025 12:07 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:STOREY, MONICAFACILITY NUMBER:
393622804
ADMINISTRATOR/
DIRECTOR:		GUARDADO, MONICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 227-8323
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY: 14TOTAL ENROLLED CHILDREN: 5CENSUS: 3DATE:
02/05/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:35 AM
MET WITH:Monica StoreyTIME VISIT/
INSPECTION COMPLETED:
12:25 PM
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On 02/05/25, Licensing Program Analyst (LPA) Elvira Sierra met with Licensee, Monica Storey for a Plan of Correction (POC) inspection. A follow up evaluation was conducted on today inspection to verify compliance for type A citation cited on 01/23/25. LPA observed Licensee caring for three children. Facility is within License capacity during visit.

LPA observed a pack and play by the sitting area that compliance with safe sleep guidelines. Type A deficiency was cleared on today's inspection. LPA also received an update Mandated Reporter Certificate that expires on 01/28/27. LPA observed Acknowledgement of Receipt of Licensing Reports (LIC 9224) on children's files.

This report and Appeal of Rights were reviewed and provided to Licensee, Monica Storey. A Notice of Site of Site visit was posted and exit interview conducted.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE: DATE: 02/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/05/2025
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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