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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393622804
Report Date: 01/14/2026
Date Signed: 01/14/2026 04:40:34 PM

Document Has Been Signed on 01/14/2026 04:40 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:		STOREY, MONICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 227-8323
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 7DATE:
01/14/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Storey, MonicaTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
NARRATIVE
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On January 14th, 2026, at 9:30APM, Licensing Program Analysts (LPAs) David Nguyen and Corina Beckby met with licensee, Monica Storey, for the purpose of an unannounced annual inspection. The purpose of the unannounced annual inspection was explained. There were seven (7) daycare children present at the time of the inspection. Licensee's operating hours are Monday through Friday from 6:00 AM. to 6:00 PM. Meals—breakfast, AM snack, lunch, PM snack, and dinner are provided to daycare children. Drinking water is also provided to daycare children with the use of bottled water and bottles. LPA discussed with licensee the balance of the annual license fees, and LPA provided licensee the balance of the annual license fees and the PIN number for online payment.

All adults subject to criminal background review have obtained criminal record clearance. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

A health and safety inspection was conducted in all areas accessible to children. The detached one-story and single-family home consists of three (3) bedrooms, two (2) bathrooms, and an attached thee-car garage. The off-limits areas in the home include all bedrooms, bathroom # 2 inside master bedroom, storage unit in the backyard, the attached 3-car garage, and the backyard. The off-limit areas are being made inaccessible by closed locked doors and SUPERVISION.

Report continues on LIC809-C... (Page 2)

NAME OF LICENSING PROGRAM MANAGER: Chayntel Hunter
NAME OF LICENSING PROGRAM ANALYST: David Nguyen
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 01/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/14/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: STOREY, MONICA
FACILITY NUMBER: 393622804
VISIT DATE: 01/14/2026
NARRATIVE
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The on-limits areas in the home include family room, living room, kitchen, dining area, and bathroom in the hallway, and hallway. LPA observed the required postings and a working phone. 3A40BC fire extinguisher meets regulations. LPA observed smoke and carbon monoxide detectors and verified they were both functional. LPA toured the kitchen area and verified knives and cleaners were inaccessible to children in care. Licensee stated there are no weapons in the home. There are no bodies of water on the premises. Outdoor play space is fenced. LPA observed a restroom and verified that hazardous and toxic items were inaccessible to children in care. Licensee stated that her FCCH facility houses one indoor/outdoor dog.

LPA observed a current roster. Licensee's immunization records for measles (MMR), pertussis (Tdap), and the flu are available in the facility file. Pediatric CPR and First Aid certification was verified and expires on 3/13/2026, and Child Care Provider Mandated Reporter certification was verified and expires on 1/28/2027.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for and removing any recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

This provider is not currently providing Incidental Medical Services (IMS) services to children in care. Licensee acknowledges that a plan for providing IMS must be submitted to the department if provided.



Report continues on LIC809-C... (Page 3)
NAME OF LICENSING PROGRAM MANAGER: Chayntel Hunter
NAME OF LICENSING PROGRAM ANALYST: David Nguyen
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2026
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: STOREY, MONICA
FACILITY NUMBER: 393622804
VISIT DATE: 01/14/2026
NARRATIVE
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22- 02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514- 0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the Licensee, Monica Storey confirmed that there are no Registered Sex Offenders living in the facility, and LPA completed the RSO profile in FAS.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Exit interview conducted and report was reviewed with the licensee, Monica Storey. Appeal rights and a notice of site visit were provided. A notice of site visit was posted 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, one (1) type-A deficiency and three (3) type-B deficiencies were cited during today’s inspection.

LPA Nguyen informed licensee, Monica Storey that this report dated (1/14/2026) documents one (1) Type-A citation which shall be posted for 30 consecutive days as there are immediate risks to the health, safety, or personal rights of children in care.



Report continues on LIC809-C... (Page 4)
NAME OF LICENSING PROGRAM MANAGER: Chayntel Hunter
NAME OF LICENSING PROGRAM ANALYST: David Nguyen
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/14/2026 04:40 PM - It Cannot Be Edited


Created By: David Nguyen On 01/14/2026 at 11:22 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: STOREY, MONICA
FACILITY NUMBER: 393622804

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/14/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

This requirement is not met as evidenced by:
Deficient Practice Statement
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4
Based on interview and record review, the licensee did not comply with the section cited above by not physically check on the infants every 15 minutes and document the 15-minute checks on the infant napping logs in which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 01/15/2026
Plan of Correction
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Licensee agrees to physically check on the infants every 15-minutes and document the 15-minute checks on the infant napping logs. Licensee agrees to submit the 15-minute infant napping logs to LPA upon completion by the POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Chayntel Hunter
NAME OF LICENSING PROGRAM MANAGER:
David Nguyen
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 01/14/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/14/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/14/2026 04:40 PM - It Cannot Be Edited


Created By: David Nguyen On 01/14/2026 at 11:22 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: STOREY, MONICA
FACILITY NUMBER: 393622804

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/14/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above by not conducting the fire drills at least once every six months in which posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/16/2026
Plan of Correction
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Licensee agrees to conduct the fire drills at least once every six months. Licensee also agrees to submit the fire drill logs to LPA upon completion by the POC due date (2/16/2026).
Type B
Section Cited
CCR
102421(a)
Child's Records
(a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above by not having a licensing file for one enrolled child in which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/28/2026
Plan of Correction
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Licensee agrees to complete the required licensing forms and obtain the parent's signatures and dates for the required licensing forms. Licensee also agrees to maintain children's licensing files. Licencess agrees to submt copies of completed and signed required licensing forms to LPA upon completion by the POC due date (1/28/2026)
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Chayntel Hunter
NAME OF LICENSING PROGRAM MANAGER:
David Nguyen
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 01/14/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/14/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/14/2026 04:40 PM - It Cannot Be Edited


Created By: David Nguyen On 01/14/2026 at 11:35 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: STOREY, MONICA
FACILITY NUMBER: 393622804

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/14/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(b)(3)(C)
102416.2 Reporting Requirements
(b) The licensee shall report to the Department any of the events… that occur during the operation of the family child care home.
(3) Health and Safety Code Section 1597.467(b)(1) provides in part: “A report shall be made to the Department…following the occurrence during the operation of a family day care home of any of the following events:

(C) Any unusual incident…that threatens the physical or emotional health or safety of any child.”

This requirement was not met as evidenced by:

Deficient Practice Statement
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Based on interview, the licensee did not comply with the section cited above by not reporting the unusual incident that occurred on 9/21/2025 to the Department within 24 hours and submit the physical UIR within 7 days in which posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/28/2026
Plan of Correction
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LPA provided licensee LIC624B for future events. Licensee agrees to watch Reporting Requirement Video and write a statement acknowledging she watched and understands the reporting requirements. Licensee also agrees to report UIRs to CCLD within 24 hours and submit the written UIRs within 7 days.

Licensee was given the general email for UIR submitting: CCLPSACS@DDS.CA.GOV
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Chayntel Hunter
NAME OF LICENSING PROGRAM MANAGER:
David Nguyen
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 01/14/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/14/2026


LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: STOREY, MONICA
FACILITY NUMBER: 393622804
VISIT DATE: 01/14/2026
NARRATIVE
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Also, LPA Nguyen informed licensee, Monica Storey to provide a copy of this licensing report dated (1/14/2026) that documents any Type-A citations to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.
NAME OF LICENSING PROGRAM MANAGER: Chayntel Hunter
NAME OF LICENSING PROGRAM ANALYST: David Nguyen
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2026
LIC809 (FAS) - (06/04)
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