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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 071441208
Report Date: 04/18/2023
Date Signed: 06/22/2023 10:54:17 AM

Document Has Been Signed on 06/22/2023 10:54 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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:DYER FAMILY CARE HOMEFACILITY NUMBER:
071441208
ADMINISTRATOR:DYER, WANDAFACILITY TYPE:
735
ADDRESS:391 BECK STREETTELEPHONE:
(510) 232-7829
CITY:RICHMONDSTATE: CAZIP CODE:
94804
CAPACITY: 4CENSUS: 1DATE:
04/18/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Wanda Dyer, AdministratorTIME COMPLETED:
03:20 PM
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On 04/18/2022 at 01:15 PM, Licensing Program Analyst (LPA) L. Holmes arrived for a third attempt, unannounced, to conduct an Annual Inspection, LPA was greeted by the Wanda Dyer, Administrator (ADM) and explained the purpose of the visit.

LPA and ADM toured the facility including, but not limited to common areas, bathroom, bedroom, kitchen and outside. Bathroom is equipped with grab bars, soap and paper towels. There was a sufficient supply of 2-day perishables and 7-day supply of non-perishable foods. Hot water temperature in the shared Clients bathroom was measured at 133.3 degrees Fahrenheit (F); however, it is under repair with PGE per notice since 04/10/23 and staff assists Client with bathroom usage. The facility temperature was 74 degrees (F). Fire extinguisher observed full and last inspected 12/08/22. Smoke and Carbon Monoxide detectors observed operational. Since the rainy season is over, LPA advised ADM to remove worn tarp from the roof of the garage and send photo. ADM to post new complaint poster.

The following forms are to be updated and submitted to CCLD on or before 04/25/2023.
-LIC500 Personnel Report
-LIC308 Designation of Administrative Responsibility (Reviewed)
-LIC610 Emergency Disaster Plan
Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE: DATE: 04/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/18/2023
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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