<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343621421
Report Date: 10/19/2023
Date Signed: 10/19/2023 10:55:48 AM


Document Has Been Signed on 10/19/2023 10:55 AM - 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: 7DATE:
10/19/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Mary DyerTIME COMPLETED:
11:10 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Kyrsten Williams met with Licensee, Mary Dyer, for the purpose of an unannounced plan of correction inspection. Census included 7 children. Licensee's daughter was also present in the home. All individuals subject to criminal background review have obtained a criminal record clearance.

LPA completed a record review of children's files. All required documents are present in each child's file. LPA will clear deficiency CCR 102417(g)(7) 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: 10/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/19/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1