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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343623829
Report Date: 10/21/2022
Date Signed: 10/21/2022 02:01:01 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/29/2022 and conducted by Evaluator Amanda Sutter
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20220729155318
FACILITY NAME:JOHNSON, ERIQUETTAFACILITY NUMBER:
343623829
ADMINISTRATOR:JOHNSON, ERIQUETTAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(669) 222-9492
CITY:ANTELOPESTATE: CAZIP CODE:
95843
CAPACITY:14CENSUS: 5DATE:
10/21/2022
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Eriquetta JohnsonTIME COMPLETED:
02:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is operating out of ratio.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On Friday, October 21, 2022, at 1:45 PM, Licensing Program Analysts (LPAs) Amanda Sutter and Soleil Marx made an unannounced visit to the facility in order to conclude and deliver findings in regards to the complaint investigation into the above allegation. LPAs met with the Licensee, Eriquetta Johnson. There were 5 children present at the facility.

The complaint alleged that the facility is operating out of ratio. Based upon interviews conducted and observations while at the facility, it could not be determined that the facility operated out of ratio. Therefore, there is not a preponderance of evidence to prove or disprove the allegation did or did not occur, therefore the above allegation is found to be UNSUBSTANTIATED.

LPA reviewed the report with the Licensee and an exit interview was conducted. Notice of site visit to be posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Amanda Sutter
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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