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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347000008
Report Date: 07/27/2023
Date Signed: 07/27/2023 03:01:32 PM


Document Has Been Signed on 07/27/2023 03:01 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:MERAKI OF SACRAMENTOFACILITY NUMBER:
347000008
ADMINISTRATOR:STIR, ANISIA & IOANFACILITY TYPE:
740
ADDRESS:4941 TYLER STREETTELEPHONE:
(916) 348-9316
CITY:SACRAMENTOSTATE: CAZIP CODE:
95841
CAPACITY:12CENSUS: 11DATE:
07/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Samantha Shaw Camachl,Administrator AssistantTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) DeAnna Williams-Lyons arrived at the facility unannounced on 7/27/2023 to conduct a Required- 1 Year Inspection utilizing the infection control domain. LPA met with Samantha Shaw Camachl, Administrator Assistant, and explained the purpose of the visit.

LPA toured the facility to ensure the health and safety of the residents in care. Areas toured include but are not limited to: 6 bedrooms and 3 bathrooms for residents, common areas, kitchen, food supply, laundry area, staff rooms, storage, and outdoor area. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and Administrator completed the infection control domain with no issues.

No deficiencies are being cited. Exit interview conducted and copy of report left at the facility.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: DeAnna Williams-LyonsTELEPHONE: (916) 212-3983
LICENSING EVALUATOR SIGNATURE:
DATE: 07/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/27/2023
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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