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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343621421
Report Date: 09/25/2023
Date Signed: 09/25/2023 03:05:57 PM


Document Has Been Signed on 09/25/2023 03:05 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 CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:DYER, MARYFACILITY NUMBER:
343621421
ADMINISTRATOR:DYER, MARYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 903-7674
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:14CENSUS: 8DATE:
09/25/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Mary DyerTIME COMPLETED:
03:20 PM
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Licensing Program Analysts (LPAs) Kyrsten Williams and Soleil Marx met with Licensee Mary Dyer for the purpose of an unannounced plan of correction inspection. Census included 8 children. Licensee's daughter was also present in the home. All individuals subject to criminal background review have obtained a criminal record clearance.

LPAs inspected all areas of the home, including off-limit areas. Off-limit areas include all bedrooms and the garage. LPAs observed no children were in any off-limit areas of the home. LPA will clear deficiency CCR 102416.3(a)(6) that was cited on 09/20/2023.

LPAs observed the licensee is operating within capacity and limitations of her licensee. LPA will clear deficiency CCR 102416.5(a) that was cited on 09/20/2023.

LPAs observed hazardous items were removed and inaccessible to children. LPA will clear deficiency CCR 102417(g) that was cited on 09/20/2023.

LPAs observed a fire drill was completed and documented on 09/21/2023. LPA will clear deficiency CCR 102417(g)(9)(A)1 that was cited on 09/20/2023.

LPAs observed documentation of 15 minute sleep checks being completed. LPA will clear deficiency CCR 102425(j)(2)(D)(c) that was cited on 09/20/2023.

Report was reviewed with Licensee Mary Dyer and exit interview was conducted. A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Kyrsten WilliamsTELEPHONE: (916) 413-0056
LICENSING EVALUATOR SIGNATURE:
DATE: 09/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/25/2023
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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