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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700650
Report Date: 09/01/2021
Date Signed: 09/01/2021 02:48:43 PM

Document Has Been Signed on 09/01/2021 02:48 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:MITCHELL, TAYLORFACILITY TYPE:
737
ADDRESS:3333 PARKS LANETELEPHONE:
(916) 609-2426
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 4CENSUS: 4DATE:
09/01/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Assistant Regional Director, Crystal TorresTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Melana Llopis arrived unannounced at the facility on 09/1/2021 for a Case Management - other visit. LPA met with Assistant Regional Director, Crystal Torres and explained the reason for the visit is to address the correct reporting requirements for COVID-19 positive cases.
LPA also spoke with Regional Director, Osiris White over the phone and informed him of the purpose for the visit as well.

Prior to the visit, LPA completed required COVID-19 testing protocols and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA ensured they applied hand sanitizer before approaching the facility and the following Personal Protective Equipment (PPE) was worn: N95 mask.

Due to the Covid-19 positive cases reported on 07/31/2021, LPA met with Assistant Regional Director outside on the picnic tables.
LPA discussed and reviewed with Assistant Regional Director and Regional Director the proper reporting procedures from PIN 20-04, stating for how any and all COVID-19 positive cases found shall be reported to the Licensing Agency.

LPA reviewed regulation 80061(b)(1)(H) with Assistant Regional Director and Regional Director.

A technical advisory note is being provided given that though the facility reported the new positive case within twenty-four hours, they did not follow the proper reporting procedures that state in PIN 20-04 and title 22 regulation, 80061(b)(1)(H), that any and all epidemic outbreaks must be reported directly to the Regional Office.

Exit interview conducted. Copy of report provided.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Melana Llopis
LICENSING EVALUATOR SIGNATURE: DATE: 08/31/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2021
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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