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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
310305298
Report Date:
09/05/2024
Date Signed:
09/05/2024 01:16:09 PM
Document Has Been Signed on
09/05/2024 01:16 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:
ST. MICHAEL RESIDENTIAL CARE HOME
FACILITY NUMBER:
310305298
ADMINISTRATOR:
SEISA, ELDA
FACILITY TYPE:
735
ADDRESS:
3345 BOWDER LANE
TELEPHONE:
(530) 823-1609
CITY:
AUBURN
STATE:
CA
ZIP CODE:
95603
CAPACITY:
11
CENSUS:
6
DATE:
09/05/2024
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
10:30 AM
MET WITH:
Patricia Chu, Elda Seisa
TIME COMPLETED:
12:00 PM
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On this date LPA Tryon and LPA Gunby visited the facility to attend a meeting between the facility and representatives from Alta Regional Center. In attendance from ACRC was BJ Thompson and Elijah Eggen.
The RC was meeting with the facility to discuss issues with medications/med administration. The home had been using an electronic MAR along with a paper MAR; and there were discrepancies between the two forms; they did not always match. The RC had given the home a plan and deadline to choose one method of tracking medications or the other (Electronic or handwritten). The home has chosen the electronic MAR at this time. Mr. Thompson discussed the plan and progress with Patricia Chu. It appears that the home has begun accurately keeping the medication records and assisting with meds. The facility will initiate training on the new system and Medication Administration with staff. Medications are secured and locked on this date.
The regional center will do another check in the home of the medications in about 2 weeks.
SUPERVISOR'S NAME:
Troy Ordonez
TELEPHONE:
(916) 263-4832
LICENSING EVALUATOR NAME:
Todd Tryon
TELEPHONE:
(916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE:
09/05/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/05/2024
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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