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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343617996
Report Date: 04/16/2021
Date Signed: 04/16/2021 12:48:39 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:SAULTER, THERESAFACILITY NUMBER:
343617996
ADMINISTRATOR:SAULTER, THERESAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 729-7102
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY:14CENSUS: 4DATE:
04/16/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:56 AM
MET WITH:Theresa SaulterTIME COMPLETED:
12:55 PM
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Due to COVID-19 pandemic, Licensing Program Analyst (LPA) Mai Lor conducted a tele-inspection via Facetime with licensee Theresa Saulter. Census included four day care children, ages are nine, eight, three and 16 months. Licensee requested to change her off-limit to on-limit. LPA Lor conducted a health and safety inspection of the master bedroom and the second bedroom at the end of the hallway (bed#2). LPA Lor approved the master bedroom and second bedroom at the end of the hallway (bed#2).

Updated off-limits: side yard, bedroom closest to the family room(bed#1), garage, master bathroom.

No deficiencies cited. Exit interview conducted.

In lieu of licensee's signature, LPA Lor is e-mailing the report with a read receipt request and notice of site visit.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Mai LorTELEPHONE: (916) 491-0182
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2021
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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