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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 312700251
Report Date: 03/13/2024
Date Signed: 03/13/2024 02:27:04 PM


Document Has Been Signed on 03/13/2024 02:27 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:BROOKFIELD HOME CAREFACILITY NUMBER:
312700251
ADMINISTRATOR:MCGILL, RAMONAFACILITY TYPE:
740
ADDRESS:5342 BROOKFIELD CIRCLETELEPHONE:
(916) 415-1012
CITY:ROCKLINSTATE: CAZIP CODE:
95677
CAPACITY:6CENSUS: 2DATE:
03/13/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Ramona McGillTIME COMPLETED:
02:30 PM
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An Informal Conference was conducted on Wednesday March 13, 2024, in the Sacramento North Regional Office. The purpose of this informal conference meeting is to discuss repeated citations regarding staff fingerprint clearance requirements within the last 12 months. Present in the meeting is Licensing Program Manager, (LPM) Maribeth Senty, Licensing Program Analyst, (LPA) Melissa Parks, and Licensee Ramona McGill.

The facility has been issued five (5) Type A citations in the past two years. The facility was cited under the following regulations: 1) Criminal record clearance, 2) Basic services requirement, and 3) Fire clearance. The licensee was informed that this Informal Conference is a part of the Administrative Action process, and that further citations may result in an elevation to a formal Non-Compliance Conference, which could lead to a referral to the Department's legal division for possible revocation of license.

Issues discussed during the meeting were:
· Non-eligible employee
· Staff clearance requirements prior to working.
· Staff Training requirements.

The facility stated they will do the following to achieve continued and substantial compliance:
· Administrator to contact Guardian and utilize for future staff hires. Secondary, contact regional office for staffing rosters if necessary.
· Utilize Technical Support Program

No deficiencies were cited during today’s meeting. An exit interview was conducted. A copy of this report was provided.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa ParksTELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:
DATE: 03/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/13/2024
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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