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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500342
Report Date: 01/16/2025
Date Signed: 01/16/2025 04:05:09 PM

Document Has Been Signed on 01/16/2025 04:05 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:EVELYN, PATRICIA; BROWN, LINDA; & JOHNSON, SHEREEFACILITY NUMBER:
394500342
ADMINISTRATOR/
DIRECTOR:		EVELYN, PATRICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 487-2610
CITY:STOCKTONSTATE: CAZIP CODE:
95219
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 4DATE:
01/16/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Brown, LindaTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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On January 16th, 2025, at 12:45 PM, Licensing Program Analyst (LPA) David Nguyen met with co-licensee, Linda Brown for the purpose of an unannounced annual inspection. The purpose of the unannounced annual inspection was explained. LPA was granted entrance into the daycare facility by co-licensee. Both licensee—Patricia Evelyn and co-licensee—Sheree Johnson were not present at time of inspection. Co-licensee—Sheree Johnson returned home at 1:47 PM. There were four (4) children present at the start of inspection. Licensee's operating hours are Monday through Friday from 4:00 AM. to 3:00 AM. Meals—breakfast, AM snack, lunch, PM snack, dinner, nighttime/bedtime snack—are provided to daycare children. Drinking water is provided to daycare children. LPA discussed the annual license fees with co-licensee and gave co-licensee the PIN number and a balance of annual license fees for online payment.

All adults subject to criminal background review have obtained criminal record clearance. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

A health and safety inspection was conducted in all areas accessible to children. The detached one-story and single-family home consists of three (3) bedrooms, two (2) bathrooms, and an attached 2-car garage. The off-limits areas in the home include the master bedroom and master bathroom, bedroom 1, bedroom # 2, the daycare room/garage, the laundry room, the backyard, and the side yards. During today’s inspection, co-licensees stated that they wanted to make the daycare room/garage, bedroom 1, and the laundry room, the backyard, and side yards off-limits. The off-limits areas remain inaccessible with closed doors and SUPERVISION. Co-licensees—Linda Brown and Sheree Johnson understand that if they want to make any off-limit area an ON-limits area, they must notify licensing, and LPA must do an inspection BEFORE children are allowed in the area.

Report continues on LIC809-C...(Page 2)

SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: David Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/16/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: EVELYN, PATRICIA; BROWN, LINDA; & JOHNSON, SHEREE
FACILITY NUMBER: 394500342
VISIT DATE: 01/16/2025
NARRATIVE
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(Page 2)
The on-limits areas in the home include the living room, the dining area, the kitchen, and the bathroom in the hallway. LPA observed the required postings and a working phone. 2A10BC fire extinguisher meets regulations. LPA observed smoke and carbon monoxide detectors in the hallway, and verified they were both functional. LPA toured the kitchen area and verified knives were inaccessible to children in care. LPA observed playroom area with age-appropriate toys for children. LPA observed a restroom and verified that hazardous and toxic items were inaccessible to children in care. Co-licensees stated there are no weapons in the home. Outdoor play space is fenced. There are no bodies of water on the premises.

Children's files were reviewed. Emergency information and required immunization records were on file. LPA observed a current roster and documentation that a fire drill is conducted at least once every six months. Licensee's immunization records are available in the facility file. Current EMSA pediatric licensee’s CPR and First Aid certification was verified and expires on 11/4/2025, and Child Care Provider Mandated Reporter certification was verified and expires on 11/7/2025.

LPA discussed the safe sleep regulations with licensees and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. LPA discussed the requirement to check and log infant napping every 15 minutes, for infants under 24 months. LPA provided Licensee a copy of LIC 9227—Individual Infant Sleeping Plan. LPA discussed the requirement to complete LIC9227-- Individual Infant Sleeping Plan for infants under twelve (12) months of age. LPA observed a 15-minute infant napping log for infants 24 months and under. LPA also observed a copy of LIC 9227--Individual Infant Sleeping Plan for infants under 12 months.

LPA discussed the Year-Round/Daily Reminder of Water Safety Requirements and Measures with co-licensees. LPA provided co-licensees the PIN 23-17-CCLD, the Year-Round and Daily Reminder of Water Safety Requirements and Measures. LPA stressed with co-licensees the importance of checking the premises for bodies of water daily prior to children’s arrival for children’s safety.
Report continues on LIC809-C...(Page 3)
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: David Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: EVELYN, PATRICIA; BROWN, LINDA; & JOHNSON, SHEREE
FACILITY NUMBER: 394500342
VISIT DATE: 01/16/2025
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This provider is not currently providing Incidental Medical Services (IMS) services to children in care. IMS policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PINs), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to [email protected]. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process

Co-licensee were informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the C0-LICENSEES, Linda Brown and Sheree Johnson confirmed that there are no Registered Sex Offenders living in the facility, and LPA completed the RSO profile in FAS.

Report continues on LIC809-C...(Page 4)
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: David Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: EVELYN, PATRICIA; BROWN, LINDA; & JOHNSON, SHEREE
FACILITY NUMBER: 394500342
VISIT DATE: 01/16/2025
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(Page 4)
Exit interview conducted and report was reviewed with co-licensees, Linda Brown and Sheree Johnson. Appeal rights and a notice of site visit were provided. A notice of site visit was posted and must remain posted for 30 days. A copy of this report will remain on file for a period of three years for public review upon request. Licensee's signature on this form acknowledges receipt of this form. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

In the areas that were evaluated, LPA Nguyen informed co-licensees, Linda Brown and Sheree Johnson that this report dated January 16th, 2025, documents one (1) Type-A citation during today’s inspection.

LPA Nguyen informed co-licensees—Linda Brown and Sheree Johnson that this report dated (01/16/2025) documents one (1) Type-A citation which shall be posted for 30 consecutive days as there are immediate risks to the health, safety, or personal rights of children in care.



Also, LPA Nguyen informed co-licensees, Linda Brown and Sheree Johnson to provide a copy of this licensing report dated (01/16/2025) that documents any Type-A citations to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: David Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/16/2025 04:05 PM - It Cannot Be Edited


Created By: David Nguyen On 01/16/2025 at 03:26 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: EVELYN, PATRICIA; BROWN, LINDA; & JOHNSON, SHEREE
FACILITY NUMBER: 394500342

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/16/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102425(b)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
Deficient Practice Statement
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LPA observed two pillows and two blankets and one bottle in the infants' play yards while the napped. Based on observation, the licensee did not comply with the section cited above in which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 01/17/2025
Plan of Correction
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Licensee and co-licensees agree to keep play yards free of loose articles and objects while the infants are napping.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Chayntel Hunter
LICENSING EVALUATOR NAME:David Nguyen
LICENSING EVALUATOR SIGNATURE:
DATE: 01/16/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/16/2025


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