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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623829
Report Date: 08/26/2024
Date Signed: 08/26/2024 02:22:50 PM

Document Has Been Signed on 08/26/2024 02:22 PM - 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: 10DATE:
08/26/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Eriquetta JohnsonTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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On August 26th 2024, Licensing Program Analysts (LPAs) Soleil Marx and Loraine Perez met with Licensee, Eriquetta Johnson, for the purpose of conducting an unannounced plan of correction inspection. The purpose of todays inspection was explained. LPAs observed a census of 10 children in care being supervised by the licensee and one assistant.

Licensee was previously cited one Type A deficiency under California Code of Regulations (CCR) 102416.5(e) for noncompliance with ratio/capacity requirements and one Type B deficiency on July 23, 2024 under California Code of Regulations (CCR) 102425(j)(2)(D)(c) for noncompliance with safe sleep requirements to document observation of sleeping infants every 15 minutes.

LPAs observed during today’s inspection that the licensee and one assistant were in compliance with ratio/capacity requirements by having ten children in care with two staff.

LPAs observed Licensee and one assistant were in compliance with safe sleep requirements by providing proof of documentation of observation of sleeping infants every 15 minutes. LPA advised Licensee to retain this documentation for department review.

During today's inspection, LPAs cleared both Type A and Type B deficiencies and provided Licensee with Deficiencies Cleared letter.

Exit interview conducted, report reviewed with licensee, Eriquetta Johnson, and notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Loraine Perez
LICENSING EVALUATOR SIGNATURE: DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/26/2024
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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