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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700650
Report Date: 03/10/2022
Date Signed: 03/10/2022 02:59:07 PM

Document Has Been Signed on 03/10/2022 02:59 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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:MERAKEY - PARKSFACILITY NUMBER:
342700650
ADMINISTRATOR:CHANESE THOMASFACILITY TYPE:
737
ADDRESS:3333 PARKS LANETELEPHONE:
(916) 609-2426
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 4CENSUS: 4DATE:
03/10/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Chrystal TorresTIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility today and met with the Administrator, Crystal Torres, to follow-up on a incident report received on 3/8/22. Facility currently does not have any COVID-19 positive cases. LPA wore surgical masks and were screened by facility upon entry. Facility staff wore masks in the care home.

The incident involved R1, R2 and R3 receiving medications on 3/7/22 at 1:20 PM.

During today’s visit, LPA interviewed Administrator. Administrator stated the incident has been addressed, staff will be retrained to facility medications and staff carry information clipboards. Administrator will review medications with physicians to clearly define medication times and windows allowable for each client and medication. Administrator will provide this information to LPA by 3/18/22.

LPA also did a verbal review of recent emergency intervention reports and provided the CARE tool list of required documentation.

No deficiencies are cited at this time.

A copy of this report has been provided to facility. Exit interview conducted.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE: DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/10/2022
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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