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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500166
Report Date: 10/10/2023
Date Signed: 10/10/2023 11:48:52 AM

Document Has Been Signed on 10/10/2023 11:48 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:JOHNSON, ONISHAFACILITY NUMBER:
394500166
ADMINISTRATOR:ONISHA DUKESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 910-2455
CITY:STOCKTONSTATE: CAZIP CODE:
95206
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
10/10/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Licensee Onisha JohsonTIME COMPLETED:
12:15 PM
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On 10/10/23, Licensing program Analyst (LPA) Carla Polanco conducted an unannounced case-management visit and met with Licensee Onisha Johnson. 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. There were 4 children present during the inspection being supervised by Licensee.

During the inspection, LPA toured and observed the backyard to be in safe conditions. As of today 10/10/23, the backyard is on limit and will be included as part of the FCCH. LPA will update the License and send to Licensee.

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: Karyn Guerra
LICENSING EVALUATOR NAME: Carla Polanco Rivera
LICENSING EVALUATOR SIGNATURE: DATE: 10/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/10/2023
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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