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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500740
Report Date: 04/17/2024
Date Signed: 04/17/2024 01:48:17 PM

Document Has Been Signed on 04/17/2024 01:48 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:CANNON, ASIAFACILITY NUMBER:
394500740
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
04/17/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:50 PM
MET WITH:Asia CannonTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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On 04/17/24, Licensing Program Analyst (LPA), Elvira Sierra met today with Licensee, Asia Cannon for a Plan of Correction (POC) inspection. A follow up evaluation was conducted on today inspection to verify correction for deficiencies cited on 04/03/24. Present in the facility were 6 preschool children being supervised by the Licensee and Licensee's assistant.

LPA checked Licensee is within License capacity during visit. LPA verified Adult #1 and Adult #2 are associated and received fingerprint clearance verified by LPA accessing Guardian. Licensee understands that adults assistants cannot be left alone with the children unless there is an adult assistant that has CPR certification. The facility is in compliance on today's visit.

This report and Appeal of Rights were reviewed and provided to the Licensee, Asia Cannon. Exit interview conducted and Notice of Site Visit was posted and should remain posted for 30 days.


SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE: DATE: 04/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/17/2024
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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