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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393622149
Report Date: 03/01/2023
Date Signed: 03/01/2023 03:23:00 PM

Document Has Been Signed on 03/01/2023 03:23 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
SACRAMENTO SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:TYSON, ANGELAFACILITY NUMBER:
393622149
ADMINISTRATOR:TYSON, ANGELAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 572-1011
CITY:STOCKTONSTATE: CAZIP CODE:
95206
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
03/01/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Licensee Angela TysonTIME COMPLETED:
03:40 PM
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On 3/1/23, Licensing program Analyst (LPA) Carla Polanco conducted an unannounced case
management visit and met with Licensee, Angela Tyson. LPA was granted entry by Licensee. Today's inspection was for the purpose of converting the off-limit backyard in the FCCH back to on-limit areas.

During today's visit there were no day-care children present.

During the inspection, LPA observed that the fence in the backyard was completely repaired. As of today the backyard is on limit and will be included as part of the FCCH. LPA will update the License and send to Licensee. There is a play structure in the backyard, the age limit is for children aged 3 years-11 years old. The age requirements were discussed. Licensee understands children under the structure age limits are not allowed on the structure for the children's safety.

Exit interview conducted and report was reviewed with the licensee. A notice of site visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

In the areas that were evaluated, no deficiencies were cited during today’s inspection.
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Carla Polanco Rivera
LICENSING EVALUATOR SIGNATURE: DATE: 03/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/01/2023
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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