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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500740
Report Date: 10/16/2024
Date Signed: 10/16/2024 02:46:47 PM

Document Has Been Signed on 10/16/2024 02:46 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: 14CENSUS: 4DATE:
10/16/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:50 PM
MET WITH:Asia CannonTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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On 10/16/24, Licensing Program Analyst (LPA) Elvira Sierra and Licensing Program Manager (LPM) Bettina Engelman conducted a Plan of Correction (POC) visit and met with Licensee, Asia Cannon. Present in the facility was License and Licensee’s assistant caring for four children. Facility is in compliance with Licence capacity on today's inspection.

During today’s visit LPA inspected daycare areas. Deficiency cited on 10/03/24 regulation section 102416.5(a) is corrected and cleared during today’s visit. Exit interview conducted. This report, and Appeal of Rights were reviewed and provided to Licensee, Asia Cannon. Notice of Site visit posted.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE: DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/16/2024
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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