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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700649
Report Date: 08/29/2024
Date Signed: 08/29/2024 10:56:59 AM

Document Has Been Signed on 08/29/2024 10:56 AM - 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:
08/29/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:40 AM
MET WITH:Program Administrator, Latisha WoodsonTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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On 08/29/24,Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility to conduct a Case Management visit regarding an incident that occurred on 08/17/24. LPA met with Program Administrator, Latisha Woodson and explained the purpose of the visit. This case management visit is conducted today to follow up on an incident that occurred at the facility on 08/17/24 regarding funds were stolen for resident, R1 as reported via incident report (SIR) and via SOC341 by facility.

SIR and SOC341 indicated that resident, R1’s funds(P & I) for amount ,$1546.86 were stolen at the facility on 08/17/24 between 7pm-11pm. Facility notified local law enforcement, ALTA regional center , responsible party regarding this incident.

LPA conducted record review and interviewed staff and residents during this visit. LPA requested incident related documents and facility shall all required documents to LPA via email by 08/31/24.

At this time, this incident is under review and department will do follow up if warranted.
Exit interview conducted and copy of the report left at facility.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE: DATE: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2024
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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