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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 11:07:20 AM

Document Has Been Signed on 03/12/2024 11:07 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 - DeficienciesUNANNOUNCEDTIME 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. At the time of arrival, a census of 13 preschool children were supervised by the licensee and her assistant. LPAs reviewed children’s files and verified that no children attending today were school age children. LPA L. Habtom reviewed the report the licensee Eriquetta Johnson. A notice of site visit was provided and appeal rights.

- Title 22 Deficiency has been cited on the attached LIC 809-D. LPA Lea Habtom informed licensee Eriquetta Johnson that this report dated March 12, 2024 documents 1 Type A citation which shall be posted for 30 consecutive days as there is an immediate risk(s) to the health, safety, or personal rights of children in care. Also, LPA Lea Habtom informed the licensee Eriquetta Johnson to provide a copy of this licensing report dated March 12, 2024 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. Appeal Rights given.

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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Document Has Been Signed on 03/12/2024 11:07 AM - It Cannot Be Edited


Created By: Lea Habtom On 03/12/2024 at 10:13 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: JOHNSON, ERIQUETTA
FACILITY NUMBER: 343623829

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/13/2024
Section Cited
CCR
102416.5(2)(a)

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102416.5(2)(a) Staffing Ratio & Capacity: A large family day care home may provide care for more than 12 children and up to and including 14 children, if all of the following conditions are met: (a) At least one child is enrolled in and attending kindergarten or
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Licensee stated she would review children's attendance to adhere to the capacity regulations. LPAs provided licensee with the regulation for a large family childcare home capacity as well as the capacity worksheet. LPAs will return to clear POC.
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elementary school and a second child is at least six years of age. This requirement was not met as evidenced by 13 preschool children were in attendance with no school age children which posses an immediate risk to the children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Keven Peters
LICENSING EVALUATOR NAME:Lea Habtom
LICENSING EVALUATOR SIGNATURE:
DATE: 03/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/12/2024


LIC809 (FAS) - (06/04)
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