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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408332
Report Date: 08/11/2022
Date Signed: 12/21/2022 12:23:11 PM

Document Has Been Signed on 12/21/2022 12:23 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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:WATKINS, RUTHFACILITY NUMBER:
073408332
ADMINISTRATOR:WATKINS, RUTHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 278-8313
CITY:ANTIOCHSTATE: CAZIP CODE:
94509
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
08/11/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Sade Honey and Angel NavaTIME COMPLETED:
01:08 PM
NARRATIVE
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THIS IS AN AMENDED REPORT FROM ORIGINAL REPORT DATED 8/11/22.
On Thursday, August 11, 2022 at 10:45 AM, Licensing Program Analyst (LPA) Caroline Colson met with Sade Honey and Angel Nava for an unannounced case management inspection. There are three preschool children and three infants present. Cheyenne Jones arrived during the inspection. A updated roster was obtained.


Appeal Rights were given and discussed. Exit interview was conducted.
SUPERVISORS NAME: Diane Perez
LICENSING EVALUATOR NAME: Mayla Mendoza
LICENSING EVALUATOR SIGNATURE: DATE: 08/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/11/2022
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 is an Amendment of Original Document on 11/03/2022 02:13 PM


Created By: Mayla Mendoza On 08/11/2022 at 11:44 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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: WATKINS, RUTH
FACILITY NUMBER: 073408332

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/11/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed




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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:Diane Perez
LICENSING EVALUATOR NAME:Mayla Mendoza
LICENSING EVALUATOR SIGNATURE:
DATE: 08/11/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/11/2022


LIC809 (FAS) - (06/04)
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