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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701161
Report Date: 12/20/2022
Date Signed: 12/20/2022 12:52:37 PM


Document Has Been Signed on 12/20/2022 12:52 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: 4DATE:
12/20/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Jessica QuistgardTIME COMPLETED:
01:15 PM
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Licensing Program Analysts (LPAs) Avelina Martinez and Arielle Pascua arrived at the facility unannounced on 12/20/2022 at 12:10 PM to conduct a POC case management visit. LPA Martinez met with Jessica Quistgard explained the purpose of the visit.

The purpose of this visit is to follow-up on plan of corrections that were due on 12/19/2022.

During today's visit, LPAs reviewed training documents regarding, basic services, personal rights, and cleaning and disinfecting. Moreover, the LPA Martinez requested the following POC’s to be corrected by: December 19, 2022. The POC's documentation was emailed to LPA Martinez on December 18, 2022. In addition, LPA Martinez and LPA Pascua toured the facility and inspected resident rooms for cleanliness.

Based upon this inspection, the LPAs observed the following POC’s to be corrected. The Deficiencies cited have been cleared. Licensee complied with the terms of the plan of correction and corrected the deficiencies by plan of correction due date.


An exit interview was held, and a copy of this report was given to the facility at the end of the visit.

SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina MartinezTELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:
DATE: 12/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/20/2022
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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