<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700007
Report Date: 09/22/2021
Date Signed: 09/22/2021 01:58:46 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:MARCONI VILLAFACILITY NUMBER:
342700007
ADMINISTRATOR:STROUP, JAMES & JENNIFERFACILITY TYPE:
740
ADDRESS:2100 MARCONI AVENUETELEPHONE:
(916) 571-5270
CITY:SACRAMENTOSTATE: CAZIP CODE:
95821
CAPACITY:6CENSUS: 4DATE:
09/22/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Laura BarneyTIME COMPLETED:
02:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Avelina Martinez made an unannounced visit to this facility to conduct an annual required inspection on 09/22/2021. LPA Martinez met with Laura Barney and explained the purpose of this visit. LPA inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyard of the facility to ensure compliance with Title 22 regulations.

The facility is licensed for 6 non-ambulatory residents, which 1 may be bedridden. Also, this facility has a hospice waiver for 4 residents. There are currently 4 residents who reside at this facility. LPA Martinez toured the facility with Laura Barney on 09/22/2021 at 1:15 PM.

The facility has one screening main entry point. The facility has a sign in sheet, which includes precautionary Covid-19 screening questions. The facility has a designated outdoor visiting area. The facility has hand sanitizer and Covid-19 postings through out the facility. The facility's common area furniture is spaced 6 feet a part. The facility is sanitary. The facility bathrooms have Covid-19 hand hygiene postings. The facility has submitted a LIC 808 mitigation plan to CCLD, which was approved.

The facility is in compliance with California Code of Regulations, Title 22 and Health and Safety Code, there were no deficiencies cited at this time.


An exit interview was held, and a copy of this report was given to the facility at the end of the visit.

SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina MartinezTELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1