342701161-4-12-2023-27-AS-AMAZ-CQTVLY-20230412163244

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 342701161
Report Date: 04/07/2023
Date Signed: 04/12/2023 04:32:46 PM

Document Has Been Signed on 04/12/2023 04:32 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 VILLA		FACILITY NUMBER:	342701161
ADMINISTRATOR:	DHANOA, MANPREET		FACILITY TYPE:	740
ADDRESS:	2100 MARCONI AVENUE		TELEPHONE:	(916) 571-5270
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95821
CAPACITY:	6	CENSUS: 6	DATE:	04/07/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Jessica Quistgard		TIME COMPLETED:	03:15 PM

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Licensing Program Analyst (LPA) Avelina Martinez made an unannounced visit to this facility to conduct an annual inspection on 04/07/2023 at 12:30 PM. LPA Martinez met with Jessica Quistgard and stated the purpose of today’s visit. LPA Martinez inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards of the facility to ensure compliance with Title 22 regulations.

Administrator holds current certificate. The facility is licensed for six non-ambulatory resident , and has an approved hospice waiver for four.

LPA Martinez toured the facility with Jessica Quistgard on 04/07/2023 at 1:30 PM.

The facility is sanitary and furnished. All resident rooms are furnished and in good repair, and the resident bathrooms are sanitary and furnished. The facility kitchen is sanitary and has an adequate food supply. The laundry is room is sanitary and laundry is done daily. All toxins are kept locked and made inaccessible resident in care. The water temperature is 108 degrees, and the facility temperature is 78 degrees. The facility fire extinguishers are in good repair, and the last fire drill was on March 23, 2023. The smoke and carbon detectors were tested and were in good repair. The facility has a call button system, and is in good repair, and the facility has a public telephone in the activities room. The exterior of the facility is in good repair. LPA Martinez reviewed 4 resident files and 5 staff files. All of the files were up to date. The facility has the required posters in the facility. LPA Martinez reviewed two Medication Administration records, which were up to date, and LPA Martinez inspected the first aid kit, which was up to date. The facility has infection control plan, and has an emergency disaster plan.

There were no deficiencies cited at today's annual inspection. An exit interview was conducted, and a copy of this report was provided to the facility.

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina Martinez	TELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2023

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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