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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624419
Report Date: 05/09/2023
Date Signed: 05/09/2023 09:18:29 AM

Document Has Been Signed on 05/09/2023 09:18 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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:FRY, DEONNAFACILITY NUMBER:
343624419
ADMINISTRATOR:FRY, DEONNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 720-5173
CITY:ORANGEVALESTATE: CAZIP CODE:
95662
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 14DATE:
05/09/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Deonna FryTIME COMPLETED:
08:50 AM
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Licensing Program Analyst Jennifer Velasco (LPA) met with the facility licensee, Deonna Fry (L1) for a case management inspection.

Due to LPA error, information was missing from the report produced during an inspection conducted 04/20/2023. Today’s inspection was conducted to obtain L1’s signature on the amended report.

The amended report and this report were reviewed and provided to L1. Notice of site visit is posted and shall remain posted for next 30 days.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Jennifer Velasco
LICENSING EVALUATOR SIGNATURE: DATE: 05/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/09/2023
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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