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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045920056
Report Date: 12/27/2023
Date Signed: 12/27/2023 04:42:15 PM

Document Has Been Signed on 12/27/2023 04:42 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:MERAKEY - INSPIRATIONSFACILITY NUMBER:
045920056
ADMINISTRATOR:HESLA, LISAFACILITY TYPE:
775
ADDRESS:3880 MORROW LANE, SUITE 30TELEPHONE:
(530) 774-2793
CITY:CHICOSTATE: CAZIP CODE:
95928
CAPACITY: 35CENSUS: 16DATE:
12/27/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Melissa Aggi Executive directorTIME COMPLETED:
04:50 PM
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Licensing Program Analyst (LPA) Sarah Benson made a Pre-licensing Inspection on today's date of 12/27/2023 and met with Executive Director Melissa Aggi. This is a Change of Ownership pre-licensing, there are currently sixteen) (16) clients at day program.

LPA toured the facility inside and out to ensure the health and safety of residents and staff present. LPA evaluated the facility based upon the Adult Residential Facility Pre-Licensing Self Certification worksheet.

LPA toured Physical Plant, Food Service, Common Areas, Bathrooms, Kitchen and Medication Storage. Fire extinguishers, smoke detectors, and fire sprinklers were observed. Kitchen was clean and in good repair, LPA observed proper storage area for food. LPA observed locked areas where items such as but not limited to, knives, medication, and toxins are stored inaccessible to residents. Hot water temperature measured within required Title 22 regulations of 105 degrees F and 120 degrees F. LPA reviewed Emergency and Disaster Preparedness Binder. Last fire drill was 10-19-23.

Based on observation and interview, it appears the facility is ready to be licensed. LPA Benson will contact Central Application Unit about this inspection.

Requirements for pre-licensing inspection met.

LPA notes no deficiencies.

Exit interview conducted and a copy of the report given to facility representative.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Sarah Benson
LICENSING EVALUATOR SIGNATURE: DATE: 12/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/27/2023
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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