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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315920008
Report Date: 09/10/2024
Date Signed: 09/10/2024 02:12:16 PM

Document Has Been Signed on 09/10/2024 02:12 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 - KINGDOMFACILITY NUMBER:
315920008
ADMINISTRATOR/
DIRECTOR:		BAGGETT, BRANDYFACILITY TYPE:
737
ADDRESS:4790 KINGDOM WAYTELEPHONE:
(530) 230-5730
CITY:SHERIDANSTATE: CAZIP CODE:
95681
CAPACITY: 4CENSUS: 0DATE:
09/10/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Brandy BaggettTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Melissa Parks arrived on Tuesday September 10, 2024 to conduct an announced prelicensing visit.

The Compliance and Regulatory Enforcement Tool was used during today's inspection. This facility has a fire clearance for 2 ambulatory and 2 nonambulatory clients, with a total capacity of 4. This facility is cleared for delayed egress and a secured perimeter. Facility has all required postings in the entry way.

LPA toured the facility with Administrator Brandy and Regional Director Chanese Thomas. The following areas were inspected for compliance: client rooms, bathrooms, medication room, kitchen, office, and backyard. Facility has current fire extinguisher, carbon monoxide detector, and fully stocked first aid kit. Water temperatures were within the required range.

Component III has been completed at this time.

The facility appears to be in substantial compliance and ready for licensure. The license will be granted upon completion of a final review and approval from the Licensing Program Manager and the Central Applications Bureau. An exit interview was conducted with Administrator and a copy of this report will be left at the facility.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE: DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2024
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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