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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343619199
Report Date: 09/17/2021
Date Signed: 09/17/2021 01:14:35 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:GUERIN, DEANIEFACILITY NUMBER:
343619199
ADMINISTRATOR:GUERIN, DEANIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 395-1916
CITY:SACRAMENTOSTATE: CAZIP CODE:
95831
CAPACITY:14CENSUS: 7DATE:
09/17/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Deanie GuerinTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Christopher Bello arrived at the facility for an unannounced inspection on 9/17/21 at approximately 8:45am. Upon arrival of the inspection LPA observed staff and provider not wearing masks. LPA consulted with the licensee regarding wearing masks during daycare hours. There were no Title 22 deficiencies during today’s investigation. An exit interview was conducted and a Notice of Site Visit posted.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Christopher BelloTELEPHONE: (916) 862-0844
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
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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