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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701028
Report Date: 05/27/2021
Date Signed: 05/27/2021 03:11:10 PM

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:MKS QUALITY CARE LLCFACILITY NUMBER:
342701028
ADMINISTRATOR:LEE, KEVINFACILITY TYPE:
740
ADDRESS:317 NATOMA ST.TELEPHONE:
(916) 831-7972
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY:15CENSUS: 0DATE:
05/27/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Kevin Lee and Maria CuciceaTIME COMPLETED:
03:20 PM
NARRATIVE
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Licensing Program Analyst (LPA) K. Hiratsuka, arrived at the facility announced on 05/272021 to conduct an announced prelicensing visit. LPA met with Applicants/Administrators Kevin Lee and Maria Cucicea and explained the purpose of the visit. Prior to initiating the prelicensing 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; contacted applicant and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. Additionally, LPA was screened by Administrator at the front door.
This has a fire clearance for all non-ambulatory. The main entrance opens to an reception area. There is a door leading to the main resident area This facility has twelve resident rooms; nine private and three shared resident rooms.. Thee rooms have full private bathroom, eight have private half-bathrooms, and one does not have any type of bathroom. There are two full common bathrooms. There are four hallways; two on each side of the facility and all have exit doors at the end. There is a laundry room that has a lock on it. There is a short hallway at the across the main entrance that has locked storage for medications and also a door leading to the outside back courtyard. The middle of the building is the main common area and kitchen. There are locked cabinets for sharp utensils.
LPA waived the component III orientation because Administrator already operates another facility. Multiple topics were discussed during this visit.
This facility meets regulations. LPA is going to submit this report to the applications specialist
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Kerry HiratsukaTELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:

DATE: 05/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2021
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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