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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 394500342
Report Date: 03/11/2025
Date Signed: 03/11/2025 02:12:37 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/24/2025 and conducted by Evaluator David Nguyen
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20250224142211
FACILITY NAME:EVELYN, PATRICIA; BROWN, LINDA; & JOHNSON, SHEREEFACILITY NUMBER:
394500342
ADMINISTRATOR:EVELYN, PATRICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 487-2610
CITY:STOCKTONSTATE: CAZIP CODE:
95219
CAPACITY:14CENSUS: 0DATE:
03/11/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Sheree JohnsonTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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1. Staff did not properly report incidents involving a daycare child.
INVESTIGATION FINDINGS:
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On March 11th, 2025, at 1:00 PM, Licensing Program Analyst (LPA) David Nguyen conducted a complaint investigation visit and met with co-licensee, Sheree Johnson. The purpose of the inspection visit was to deliver the findings for the above allegation. LPA disclosed the purpose of the inspection and was granted entrance into the daycare facility by co-licensee. LPA observed no children at the start of the inspection. LPA toured the on-limit areas, during the inspection.

During the course of the investigation, LPA conducted interviews with licensee, co-licensees, parents, and reporting party. In addition, LPA obtained information pertaining to the allegation. It was alleged that “Staff did not properly report incidents involving a daycare child.” Based on interviews with licensee, co-licensees, parents, and reporting party, LPA obtained corroborating information from licensee, co-licensees, and reporting party. Based on records review, it revealed that co-licensee 2 (CL2) did not properly report the minor injuries of a daycare child (C1) to reporting party (RP).

Report continues on subsequent page LIC9099...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: David Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 53-CC-20250224142211
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 03/11/2025
NARRATIVE
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Based on records reviewed and interviews conducted, it was determined that the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. The following Title 22 Deficiency is being cited on the subsequent 9099-D page.

Appeal Rights and Notice of Site Visit were provided. Notice of Site Visit must remain posted for 30 days.



Exit interview conducted and report was reviewed with co-licensee, Sheree Johnson. A notice of site visit was provided and must remain posted for 30 days. Co-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.

LPA Nguyen informed co-licensee, Sheree Johnson that this report dated March 11th, 2025, documents one (1) Type-A citation during the course of investigation.

SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: David Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 53-CC-20250224142211
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/11/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/07/2025
Section Cited
CCR
102423(a)(2)
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102423 (a) Each child receiving services from a family child care home shall have certain rights… These rights include...the following: (2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment. This requirement was not met as evidenced by:
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Licensee and co-licensees agree to forfeit the FCCH license.
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Based on records reviewed and interviews conducted, it was revealed that C1 had multiple incidents and CL2 did not report the incidents to RP. This poses an immediate health, safety, or personal rights risk to children 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.
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: David Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/24/2025 and conducted by Evaluator David Nguyen
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20250224142211

FACILITY NAME:EVELYN, PATRICIA; BROWN, LINDA; & JOHNSON, SHEREEFACILITY NUMBER:
394500342
ADMINISTRATOR:EVELYN, PATRICIAFACILITY TYPE:
810
ADDRESS:6378 EMBARCADERO DRTELEPHONE:
(209) 487-2610
CITY:STOCKTONSTATE: CAZIP CODE:
95219
CAPACITY:14CENSUS: 0DATE:
03/11/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Sheree JohnsonTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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1. Staff did not provide adequate supervision to a daycare child.
2. Staff did not meet a daycare child’s dietary need.
3. Staff did not share with an authorized representative the complaint details.
4. Staff inappropriately restrained the daycare children.
5. Staff made an inappropriate comment towards a daycare child.
INVESTIGATION FINDINGS:
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On March 11th, 2025, at 1:00 PM, Licensing Program Analyst (LPA) David Nguyen conducted a complaint investigation visit and met with co-licensee, Sheree Johnson. The purpose of the inspection visit was to deliver the findings for the above allegations. LPA disclosed the purpose of the inspection and was granted entrance into the daycare facility by co-licensee. LPA Nguyen observed no children at the start of the inspection. LPA toured the on-limit areas, during the inspection.

It was alleged that staff did not provide adequate supervision to a daycare child, staff did not meet a daycare child’s dietary need, staff did not share with an authorized representative the complaint details, staff inappropriately restrained the daycare children, and staff made an inappropriate comment towards a daycare child.
Throughout the investigation, LPA Nguyen interviewed with licensee, co-licensees, parents, and reporting party.

Report continues on subsequent page LIC9099...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: David Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 53-CC-20250224142211
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 03/11/2025
NARRATIVE
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Based on interviews with licensee, co-licensees, and parents, LPA Nguyen learned that no information disclosed that staff did not provide adequate supervision to a daycare child, staff did not meet a daycare child’s dietary need, staff did not share with an authorized representative the complaint details, staff inappropriately restrained the daycare children, and staff made an inappropriate comment towards a daycare child.

Based the statements from licensee, co-licensees, and parents, and the conflicting information from reporting party, LPA Nguyen determined that the above complaint allegations were found to be UNSUBSTANTIATED, meaning although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur at the daycare facility.

Copy of this report was reviewed and provided to co-licensee, Sheree Johnson. Notice of site visit is posted and shall remain posted for next 30 days.

An exit interview was conducted with co-licensee, Sheree Johnson. 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.
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: David Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5