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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623829
Report Date: 03/12/2024
Date Signed: 03/12/2024 11:05:59 AM

Document Has Been Signed on 03/12/2024 11:05 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 CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:JOHNSON, ERIQUETTAFACILITY NUMBER:
343623829
ADMINISTRATOR:JOHNSON, ERIQUETTAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(669) 222-9492
CITY:ANTELOPESTATE: CAZIP CODE:
95843
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 13DATE:
03/12/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Eriquetta JohnsonTIME COMPLETED:
11:15 AM
NARRATIVE
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On March 12, 2024, Licensing Program Analysts (LPAs) Lea Habtom and Lorainne Perez arrived at the location for the purpose of an unannounced case management inspection for a self reported unusual incident report. The census for today was 13 preschool children being supervised by licensee and her assistant. All individuals present during today’s inspection have fingerprint clearances and associations.

On February 8, 2024, a preschool child was in the classroom playing when the licensee noticed the child closing their eyes. The licensee was also in the classroom with the children. The child began to jerk and the licensee went over to the child and picked up the child. Licensee held the child and called 911. The emergency services directed the licensee on what to do and she also contacted the child’s parents. The child was transported to the emergency room via an ambulance. The child did not have a fever at the start of the morning and when licensee checked the child’s temperature it was 98 degrees. The licensee was provided with a written statement from the child’s doctor on Sutter Health letterhead that stated the child does not have a health disorder and does not require medication. The doctor believes the child may not be prone to another medical incident and if one occurs licensee was given written direction from the doctor on how to handle the situation.

This report was reviewed with licensee, Eriquetta Johnson. A notice of site visit was provided to be posted for 30 days. Appeal rights provided.

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Lea Habtom
LICENSING EVALUATOR SIGNATURE: DATE: 03/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/12/2024
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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