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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343617984
Report Date: 08/30/2022
Date Signed: 08/30/2022 10:12:05 AM

Document Has Been Signed on 08/30/2022 10:12 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:MAHONEY, JENNIFERFACILITY NUMBER:
343617984
ADMINISTRATOR:MAHONEY, JENNIFERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 735-7940
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
08/30/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Jennifer MahoneyTIME COMPLETED:
10:30 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
On August 30, 2022 Licensing Program Analysts (LPAs) Lea Habtom and Amanda Blesi met with licensee Jennifer Mahoney for an unannouced case management visit. The purpose for today's visit is to provide licensee with an amended report for the findings delivered on August 23, 2022.

Today's census consisted of 3 infants under the age of 2 being supervised by licensee. No other adults were present in the home during today's inspection.

There were no title 22 violations cited during today's visit.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Lea Habtom
LICENSING EVALUATOR SIGNATURE: DATE: 08/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/30/2022
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