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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700370
Report Date: 09/21/2020
Date Signed: 09/28/2020 09:41:03 AM

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:PRAIRIE CITY LANDINGFACILITY NUMBER:
342700370
ADMINISTRATOR:MARTIN, CHERYL KFACILITY TYPE:
740
ADDRESS:645 WILLARD DRTELEPHONE:
(916) 458-0303
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY:200CENSUS: 140DATE:
09/21/2020
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Cheryl Martin (Administrator)TIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Konnor Leitzell contacted the facility via of an office call via conference call. Due to COVID-19 and pre-cautionary measures. LPA Konnor Leitzell discussed the purpose of the call with Cheryl Martin – Administrator. The following attendees were present on the call: Alycia Berryman – Regional Manager, Sacramento North, Troy Ordonez, Licensing Program Manager, Sacramento County Public Health, Paula Hertel, Operations Consultant and Thomas Bahrman, Company President.

The purpose of the call was to discuss the facility role of testing related to resident and staff for COVID-19. Also discussed were the prevention, containment and mitigation measures in place by the facility and next steps needed. CCL also discussed Provider Information Notice (PIN) 20-23 and the protocol steps for testing.

As agreed, the facility will submit a plan for scheduling testing and testing results for the staff. Facility will undergo testing 25% of all staff, each week for a total of eight (8) weeks. Conversation will be had after four (4) weeks discussing the second round of testing.

Testing results shall be sent to CCL after received. The facility also agreed to follow the guidance as outlined by local health department related to testing.

The Administrator was advised that at this time the office call may require further possible follow-up telephone calls or visits are necessary.

An exit interview was conducted with Cheryl Martin (Administrator) via telephone and a copy of this report along was provided to administrator via email and an electronic email read receipt confirms receiving these documents.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Konnor LeitzellTELEPHONE: (916) 708-9618
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2020
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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