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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 071441208
Report Date: 12/06/2024
Date Signed: 12/10/2024 12:45:42 PM

Document Has Been Signed on 12/10/2024 12:45 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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:DYER FAMILY CARE HOMEFACILITY NUMBER:
071441208
ADMINISTRATOR/
DIRECTOR:
DYER, WANDAFACILITY TYPE:
735
ADDRESS:391 BECK STREETTELEPHONE:
(510) 232-7829
CITY:RICHMONDSTATE: CAZIP CODE:
94804
CAPACITY: 4CENSUS: 1DATE:
12/06/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:05 AM
MET WITH:Wanda Dyer, Administrator TIME VISIT/
INSPECTION COMPLETED:
01:10 PM
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On 12/10/2024 around 10:05 AM, Licensing Program Analyst (LPA) L. Holmes arrived to complete and conduct an announced required Annual Inspection that was last attempted on 12/06/24. LPA met with Wanda Dyer, Administrator (ADM) and explained the purpose of the visit. The facility’s fire clearance was approved for four (4) ambulatory clients. Facility has one (1) client and approved for ambulatory residents ages 18-59.

ADM continues to have COVID-19 signage posted throughout the facility. LPA toured the facility including, but not limited to common areas, bathroom, bedrooms, kitchen and surrounding areas. Handwashing signs and covered garbage cans are in place. Bathrooms were equipped with grab bars, soap, paper towels and in sanitary condition. Hot water temperature in the shared clients' bathroom measured at 119.7 degrees Fahrenheit (F) and facility temperature was 73 degrees (F). Fire extinguisher observed full; tag needs to be replaced from last inspection on 12/08/24. Smoke and Carbon Monoxide detectors observed operational. First aid complete. LPA reviewed age exception, two (2) staff and one (1) Client records. Advised ADM to update the Emergency Disaster Plan with a second relocation shelter.

The following forms are to be updated and submitted to CCLD on or before 12/24/2024.
-LIC500 Personnel Report
-LIC308 Designation of Administrative Responsibility
-LIC610 Emergency Disaster Plan
-Liability Insurance

No deficiencies cited. Exit interview conducted and a copy of this report provided to ADM.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE: DATE: 12/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/06/2024
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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