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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483010590
Report Date: 01/29/2026
Date Signed: 01/29/2026 02:22:19 PM

Document Has Been Signed on 01/29/2026 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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:MCCOY, JOURNEY FCCHFACILITY NUMBER:
483010590
ADMINISTRATOR/
DIRECTOR:		MCCOY, JOURNEYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 342-4597
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY: 12TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
01/29/2026
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:31 PM
MET WITH:Journey MccoyTIME VISIT/
INSPECTION COMPLETED:
02:36 PM
NARRATIVE
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Licensing Program Analyst (LPA), Robert Maciel made an unannounced visit to the facility for the purpose of conducting a complaint investigation visit. This Case Management visit is added to today’s visit as a result of information obtained during today’s complaint investigation. LPA met with Licensee, Journey McCoy (LS).

During an interview, LS stated that she did not inform Licensing of the incident on 1/27/26 in which children eloped from the facility and did not submit an Unusual Incident Report, form LIC624, as required. LS stated that she was unsure if reporting was required because the Vallejo police department was called and officers did enter to inspect the home.

Additionally, LS stated that on 1/27/26, 10 children were present in the home. Assistant S1 stated she left the home at approximately 11:10 AM and returned between 11:20 AM and 11:30 AM.

During review of children's records, LS stated that the Roster of Children in care did not contain entries for C1, C2, C4, and C6 and did not possess complete children's files for C2 and C6.

The following violation of the California Code of Regulations, Title 22; Division 12, were observed: see LIC809D. Appeal Rights were provided.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Licensee Journey McCoy.

NAME OF LICENSING PROGRAM MANAGER: Melchisedeck Augustin
NAME OF LICENSING PROGRAM ANALYST: Robert Maciel
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 01/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/29/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 01/29/2026 02:22 PM - It Cannot Be Edited


Created By: Robert Maciel On 01/29/2026 at 01:17 PM
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
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: MCCOY, JOURNEY FCCH
FACILITY NUMBER: 483010590

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/29/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/06/2026
Section Cited
CCR
102416.2

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(2) Any child absence means any instance where a child in care is missing. For example, any child in care who wanders away from the Family Child Care Home, is lost during an outing, or does not return from school, shall be reported even if the child is later found safe.

This requirement was not met as evidenced by:
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Licensee stated she would submit an unusual incident report regarding the incident on 1/27/26 on the LIC624 form to the department by 2/6/26
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Based on interview, Licensee and staff were aware of the the incident in which two children, C1 and C2, eloped from the facility but did not report the incident to the department or submit a written unusual incident report which poses a potential risk to the health, safety, or personal rights to persons in care.
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Type B
02/06/2026
Section Cited
CCR102416.5(e)

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If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c).

This requirement was not met as evidenced by:
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Licensee stated she would review the ratio and capacity regulations and submit a written statement attesting to her understanding of the regulations to LPA by email at robert.maciel@dss.ca.gov by 2/6/26
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Based on interview, Licensee stated that on 1/27/26, there were 10 children present at the facility. S1 stated that she was absent from the facility between approximately 11:10 AM and 11:20-11:30 AM which poses a potential risk to the health, safety, or personal rights of persons 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.
Melchisedeck Augustin
NAME OF LICENSING PROGRAM MANAGER:
Robert Maciel
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 01/29/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/29/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/29/2026 02:22 PM - It Cannot Be Edited


Created By: Robert Maciel On 01/29/2026 at 01:26 PM
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
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: MCCOY, JOURNEY FCCH
FACILITY NUMBER: 483010590

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/29/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/06/2026
Section Cited
CCR
102421(a)

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(a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d).

This requirement was not met as evidenced by:
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Licensee stated she would update the roster of children in care to include entries for all currently enrolled children and submit a copy to LPA by email at robert.maciel@dss.ca.gov by 2/6/26
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Based on record review and interview, facility roster of children in care did not contain entries for C1, C2, C4, and C6 which poses a potential risk to the health, safety, or personal rights of persons in care.
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Type B
02/06/2026
Section Cited
CCR102418(h)(1)

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The family day care home shall record each pupil's immunization on the California School Immunization Record, PM 286 (6/95)

This regulation was not met as evidenced by
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Licensee stated she would obtain the required documents for C2 and C6's child file and send a copy to LPA by email at robert.maciel@dss.ca.gov by 2/6/26
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Based on interview, Licensee stated that she did not possess child files for C2 and C6 except for the immunization record but that it was not recorded onto the CDPH286 form which poses a potential health, safety or personal rights risk to persons 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.
Melchisedeck Augustin
NAME OF LICENSING PROGRAM MANAGER:
Robert Maciel
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 01/29/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/29/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/29/2026 02:22 PM - It Cannot Be Edited


Created By: Robert Maciel On 01/29/2026 at 01:34 PM
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
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: MCCOY, JOURNEY FCCH
FACILITY NUMBER: 483010590

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/29/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/06/2026
Section Cited
CCR
102421(b)

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(b) The licensee shall maintain, in each child's record, a copy of the emergency information card as required
in Section 102417(g)(7).

This requirement is not met as evidenced by:
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Licensee stated she would obtain the required documents for C2 and C6's child file and send a copy to LPA by email at robert.maciel@dss.ca.gov by 2/6/26
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Based on interview, Licensee stated that she did not possess complete child files for C2 and C6 which poses a potential health, safety or personal rights risk to persons in care.
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Type B
02/06/2026
Section Cited
CCR102419(d)(1)

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(1) The licensee shall request the child's parent or authorized representative to sign and date the bottom portion of the notice form LIC 995A (8/06), which acknowledges that the parent or authorized representative has received and read the LIC 995A. The bottom portion of this form
must be kept in the child’s file as proof...
This requirement is not met as evidenced by:
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Licensee stated she would obtain the required documents for C2 and C6's child file and send a copy to LPA by email at robert.maciel@dss.ca.gov by 2/6/26
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Based on interview, Licensee stated that she did not possess complete child files for C2 and C6 which poses a potential health, safety or personal rights risk to persons 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.
Melchisedeck Augustin
NAME OF LICENSING PROGRAM MANAGER:
Robert Maciel
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 01/29/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/29/2026


LIC809 (FAS) - (06/04)
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