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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623829
Report Date: 04/04/2024
Date Signed: 04/04/2024 11:46:18 AM

Document Has Been Signed on 04/04/2024 11:46 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/
DIRECTOR:		JOHNSON, ERIQUETTAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(669) 222-9492
CITY:ANTELOPESTATE: CAZIP CODE:
95843
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
04/04/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:55 AM
MET WITH:Eriquetta JohnsonTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On Thursday April 4, 2024, Licensing Program Analyst (LPA) Lea Habtom arrived at the location to conduct an unannounced case management plan of correction inspection. LPA L. Habtom met with license, Eriquetta Johnson. The census for today is 11 children consisting of 1 infant over 12 months and 10 preschool children being supervised by licensing and her assistant. All adults present in the home today have fingerprint clearances and associations.

The purpose of today's inspection is to confirm that the licensee cleared the deficiency cited during a case management inspection conducted on March 12, 2024. LPA L. Habtom confirmed that the licensee is in ratio during today's inspection.

Based on today's inspection, LPA L. Habtom has cleared the citation and provided the licensee with a plan of correction letter.

No Title 22 regulations were cited during today's inspection. 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: 04/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/04/2024
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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