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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002896
Report Date: 04/24/2024
Date Signed: 04/24/2024 09:37:52 AM


Document Has Been Signed on 04/24/2024 09:37 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:MARATHA MANORFACILITY NUMBER:
345002896
ADMINISTRATOR:NWAUKONI, BENEDICTAFACILITY TYPE:
740
ADDRESS:5416 WOODED GLEN PLACETELEPHONE:
(510) 860-2927
CITY:ANTELOPESTATE: CAZIP CODE:
95843
CAPACITY:6CENSUS: 3DATE:
04/24/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Staff- Pius NwaukoniTIME COMPLETED:
09:40 AM
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On 04/24/24, Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived unannounced at the facility to conduct a Plan of Correction (POC) visit regarding the deficiencies LPA cited the facility on 04/03/24 during an annual inspection. LPA met with Staff Pius Nwaukoni and explained the purpose of the visit. LPA requested for staff to notify Administrator, Benedicta Nwaukoni, of LPA's presence at the facility. Administrator was unable to meet at the facility and gave staff permission to assist LPA during today's visit.

LPA explained to Administrator and staff that failure to correct plan of correction by the given due date could and will result to $100 per day until corrected civil penalty.

During today's visit, Administrator informed LPA that they will submit the POC by the end of the day.

ยท CCR 87755 Inspection Authority of the Licensing Agency

As a result of today's inspection, civil penalties were assessed.

Exit interview conducted and a copy of the report and appeal rights provided.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Cheyenne RatajczakTELEPHONE: (916) 969-7879
LICENSING EVALUATOR SIGNATURE:
DATE: 04/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/24/2024
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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