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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 553600665
Report Date: 10/15/2021
Date Signed: 10/15/2021 02:04:01 PM

Document Has Been Signed on 10/15/2021 02:04 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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:LIEDTKE, BONNIEFACILITY NUMBER:
553600665
ADMINISTRATOR:LIEDTKE, BONNIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 533-1646
CITY:SONORASTATE: CAZIP CODE:
95370
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
10/15/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:21 PM
MET WITH:Bonnie LiedtkeTIME COMPLETED:
02:10 PM
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On 10/15/2021 at 1:21 PM Licensing Program Analyst (LPA) Jeevun Birk-Miller conducted an unannounced case management inspection and met with Licensee, Bonnie Liedtke. The purpose of the inspection was to confirm the removal of individual, Suzanne Dougherty. At this time there are no children in care. The Licensee’s husband and adult grandson were present. Licensee stated that her granddaughter, Suzanne has not worked or resided in the home in years. LPA toured the facility and observed all of the bedrooms. Based on the observations, LPA verified Suzanne Dougherty is not present, employed or resides at the facility. Licensee returned the confirmation of removal form (LIC300A) to LPA Birk-Miller.

During the inspection the Licensee had to leave. LPA stated she would leave the report at the facility. LPA asked the Licensee to sign the report and mail it back to the Regional Office. LPA also printed and provided documents for the Licensee as requested. An exit interview was conducted. A Notice of Site visit was given and is to be posted for 30 days.
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Jeevun Birk
LICENSING EVALUATOR SIGNATURE: DATE: 10/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/15/2021
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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