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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343625191
Report Date: 09/12/2024
Date Signed: 09/12/2024 09:58:18 AM

Document Has Been Signed on 09/12/2024 09:58 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:DYACHISHIN, ANNETTEFACILITY NUMBER:
343625191
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
09/12/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:50 AM
MET WITH:Annette DyachishinTIME VISIT/
INSPECTION COMPLETED:
10:20 AM
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On September 12, 2024, Licensing Program Analyst (LPA), Michelle Perez, met with licensee Annette Dyachishin for the purpose of a plan of correction visit. LPA observed licensee present, with assistant and four children, including licensees own minor infant child.

On September 3, 2024, LPA conducted an unannounced inspection, and licensee was not present. Licensee was cited with not being present 80% of operating hours.

LPA returned today, to verify licensee's presence and to clear the deficiency.

Licensee also requested to place bedroom number 2, on limits, as previously it was listed as off-limits. Effective today, September 12, 2024, bedroom number two will remain on-limits. Licensee will keep children out of the remaining off-limit areas.

Licensee is also in the process of applying for a large license and will submit application package when complete.

There are no deficiencies cited during today's visit.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Michelle Perez
LICENSING EVALUATOR SIGNATURE: DATE: 09/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/12/2024
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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