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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701161
Report Date: 05/05/2022
Date Signed: 05/05/2022 03:14:37 PM


Document Has Been Signed on 05/05/2022 03:14 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833



FACILITY NAME:MARCONI VILLAFACILITY NUMBER:
342701161
ADMINISTRATOR:DHANOA, MANPREETFACILITY TYPE:
740
ADDRESS:2100 MARCONI AVENUETELEPHONE:
(916) 571-5270
CITY:SACRAMENTOSTATE: CAZIP CODE:
95821
CAPACITY:6CENSUS: 5DATE:
05/05/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Manpreet DhanoaTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Victoria Brown arrived unannounced on 5/5/22 at 1:00PM to conduct a Pre-licensing inspection visit. LPA met with Manpreet Dhanoa and explained the purpose of the visit. Administrator certificate expires 11/24/23 for Manpreet Dhanoa.. The licensing fees are current at this time.

The facility is licensed for a capacity of 6 non-ambulatory residents. LPA toured and inspected the physical plant inside and outside to ensure there are no safety hazards to residents. LPA observed 5 residents during this visit.

LPA observed 2-day perishables and a supply of 7-day non-perishables during this visit. Facility has video cameras in the common areas. LPA observed exit alarms during this visit. Administrator demonstrated the use of Medication Administration Record (MAR).

The temperature inside the facility was observed to be at 75*F which is within the required range of 68-85*F. The hot water temperature was measured at 114.2*F which is within the required range of 105-120*F.

LPA observed fire extinguisher(s), smoke and carbon monoxide detectors, and central heating and air in the facility. LPA observed the centrally stored medications area to be locked and inaccessible to residents. The first aid kit contained the required items such as sterile dressings, bandages, adhesive tape, scissors, tweezers, thermometers, antiseptic solution and guide.

Component III conducted-Licensure pending.

Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies observed or cited. Exit interview held, copy of report given.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Victoria BrownTELEPHONE: (209) 814-1955
LICENSING EVALUATOR SIGNATURE:
DATE: 05/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/05/2022
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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