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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700266
Report Date: 06/07/2022
Date Signed: 06/07/2022 09:32:09 AM

Document Has Been Signed on 06/07/2022 09:32 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:JOHNSON FAMILY CHILD CAREFACILITY NUMBER:
367700266
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
06/07/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:59 AM
MET WITH:Tanisha JohnsonTIME COMPLETED:
09:45 AM
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Licensing Program Analyst (LPA) Thompson-Miller met with Applicant/Licensee Tanisha Johnson for a Change of Location Prelicensing Inspection for a large child care home license. Upon arrival there were 2 children in care (siblings).

At start of the inspection the required Fire Extinguisher (2A10BC) fell and burst. Smoke went throughout the home and alarms went off.

LPA will reschedule inspection due to smoke and dust in the home.

Exit interview conducted and a copy of this report was provided to Applicant/Licensee Tanisha Johnson.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Linda Thompson-Miller
LICENSING EVALUATOR SIGNATURE: DATE: 06/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/07/2022
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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