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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700649
Report Date: 08/27/2024
Date Signed: 08/27/2024 01:36:50 PM

Document Has Been Signed on 08/27/2024 01:36 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 - PEAR ORCHARDFACILITY NUMBER:
342700649
ADMINISTRATOR/
DIRECTOR:		JORDAN TRACYFACILITY TYPE:
735
ADDRESS:9029 PEAR ORCHARD COURTTELEPHONE:
(916) 609-2424
CITY:ORANGEVALESTATE: CAZIP CODE:
95662
CAPACITY: 4CENSUS: 3DATE:
08/27/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:35 AM
MET WITH:Program Administrator, Latisha WoodsonTIME VISIT/
INSPECTION COMPLETED:
01:55 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
On 08/27/24, Licensing Program Analyst (LPA) Talwinder Bains arrived unannounced to conduct a required annual inspection. LPA met with staff, DSP. Rudy Morgan and explained purpose of inspection. LPA observed all 3 clients in the facility during today's visit. DSP called Program Administrator, Latisha Woodson who came later and assisted with today's visit.

LPA and DSP toured the interior and exterior of the facility including the common areas, client bedrooms, client bathrooms, kitchen, laundry area/garage. LPA observed the home to be clean, safe and in good repair and to not pose a health and safety risk or personal rights violation. LPA observed various Covid posters throughout as well as other required postings, including House Rules and personal rights. Inside temperature was observed to be 74* F. Fire extinguisher last serviced 05/13/24. Facility conducts monthly fire and disaster drills, at different hours of the day. The facility has a large back yard area with seating. There are no pools/ponds. LPA observed locked toxins in the laundry area and locked medications in a separate cabinet. LPA observed sufficient 2+day perishable/7+day non-perishable food and sufficient PPE on hand. LPA observed paper towels, soap, sanitizer, trash cans and hand-washing posters in the bathroom. Water temperature measured 110*degree F in the kitchen. Smoke/monoxide alarms were in working order. Games/activities observed on site.

LPA reviewed two (2) clients files and two (2) staff files and found the required documentation on file, including staff training. LPA reviewed medications for two (2) clients and found no errors.


No deficiencies were observed and cited today per Title 22 Regulations.
Exit interview conducted. A copy of this report was provided.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE: DATE: 08/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/27/2024
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 2