<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500999
Report Date: 10/08/2024
Date Signed: 10/08/2024 11:24:43 AM

Document Has Been Signed on 10/08/2024 11:24 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 SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:DOUGLASS, KATHERYNE & GOMEZ, KARENFACILITY NUMBER:
394500999
ADMINISTRATOR/
DIRECTOR:		DOUGLASS, KATHERYNEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 513-0576
CITY:STOCKTONSTATE: CAZIP CODE:
95215
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
10/08/2024
TYPE OF VISIT:OfficeANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Katheryne DouglassTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On October 8, 2024, Regional Manager (RM), Roxana Saravia, Licensing Program Managers (LPMs) Chayntel Hunter and Bettina Engelman, and Licensing Program Analysts (LPAs) Stacey Williams, Lauren Scott, and Janie Davis met with Licensee, Katheryne Douglass for the purpose of an Informal Office Meeting. RM defined the difference between a Non-Compliance and an Informal Meeting. RM advised Licensee the purpose of today’s meeting is to ensure compliance is met.

Today's informal meeting was to discuss the requirements for Licensees operating a family childcare home. Regulation 102417 was reviewed with Licensee. Licensee was reminded that all Licensees are required to be present in the facility for eighty percent of the facility hours per day. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.

Licensee Gomez stated that she will discuss licensure requirements and inactive status options with her Co-Licensee (Gomez) and determine next steps. Licensee Douglass was provided with licensing forms: Application for a Family Childcare License and Request for Inactive Childcare Status.

This report was reviewed by Licensee, Katheryne Douglass.

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Stacey Williams
LICENSING EVALUATOR SIGNATURE: DATE: 10/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/08/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1