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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
345002817
Report Date:
09/21/2022
Date Signed:
09/21/2022 01:18:48 PM
Document Has Been Signed on
09/21/2022 01:18 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
,
520 COHASSET RD., STE. 170
CHICO
,
CA
95926
FACILITY NAME:
MERYL'S CARE HOME
FACILITY NUMBER:
345002817
ADMINISTRATOR:
ABELARDO, BERYL
FACILITY TYPE:
740
ADDRESS:
9495 DEANNA AVE.
TELEPHONE:
(916) 467-2492
CITY:
ORANGEVALE
STATE:
CA
ZIP CODE:
95662
CAPACITY:
6
CENSUS:
5
DATE:
09/21/2022
TYPE OF VISIT:
Post Licensing
UNANNOUNCED
TIME BEGAN:
12:35 PM
MET WITH:
Facility Staff- Roselle Abelardo
TIME COMPLETED:
01:30 PM
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Post Licensing visit is conducted in today's inspection.
No deficiencies are cited.
See LIC809 for Annual visit for details.
Exit interview done and copy of the report left at facility.
SUPERVISORS NAME
:
Laura Munoz
LICENSING EVALUATOR NAME
:
Talwinder Bains
LICENSING EVALUATOR SIGNATURE
:
DATE:
09/21/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/21/2022
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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