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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315920123
Report Date: 06/12/2024
Date Signed: 06/12/2024 03:59:18 PM


Document Has Been Signed on 06/12/2024 03:59 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, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833



FACILITY NAME:MORGAN CREEK COMFORT CARE HOMEFACILITY NUMBER:
315920123
ADMINISTRATOR:RAZA, SARDAR ALIFACILITY TYPE:
740
ADDRESS:9660 PINEHURST DRIVETELEPHONE:
(414) 243-1004
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY:6CENSUS: 0DATE:
06/12/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Sardar Ali Raza, LicenseeTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Bethany Mirlohi arrived announced to conduct a pre-licensing inspection. LPA met with Licensee/Administrator Sardar Ali Raza during today's visit. Currently there are no clients residing within the facility.

Facility was inspected both indoors and outdoors. LPA inspected client bedrooms, bathrooms, common living areas, garage and kitchen. Outdoor area is free from hazardous debris. Outdoor exits are clear and accessible. First aid kit was present in the facility. Centrally stored medications will be locked in the kitchen cabinets. The facility has adequate lighting throughout. LPA inspected client bedrooms and the bedroom had appropriate furnishings, chair, adequate lighting and storage. Bathrooms are clean, sanitary, and in good repair. Smoke detectors and carbon monoxide detectors were operational. Fire clearance was granted on 01/29/2024 for 5 non-ambulatory clients and 1 bedridden client. Kitchen is clean, sanitary, and in good repair. A working telephone has been set up for client use.

During facility inspection LPA found resident bathrooms did not have grab bars set up by the toilets. Licensee to install grab bars in bathrooms and LPA will return on a later date.

COMP III was completed during today's inspection.

Exit interview and copy of report provided.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany MirlohiTELEPHONE: (916) 204-8288
LICENSING EVALUATOR SIGNATURE:
DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/12/2024
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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