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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347000008
Report Date: 06/13/2024
Date Signed: 06/13/2024 03:50:15 PM


Document Has Been Signed on 06/13/2024 03:50 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: 9DATE:
06/13/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Samantha Shaw- Comacho TIME COMPLETED:
04:00 PM
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On 6/13/24, LPA Mknelly conducted a POC visit for citation issued on 6/7/24 with POC due by 6/10/24. LPA met with house manager and explained the reason for the visit.

Upon arrival LPA observed that the front gate is not locked from inside the gate.

The department has not received the POC: plan for staffing to address resident wandering and exit seeking behaviors as well as a waiver request if they wish to pursue the necessary clearance for a locked perimeter (See 87705(I) for waiver requirements) as of this date.

LPA and house manager again discussed the needed components of the plan, that civil penalties are being assessed today and that the penalty will continue to accrue until the POC is faxed to the department.

As a result of today's visit, no additional citations are being issued at this time.

Report reviewed and copy provided.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:
DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/13/2024
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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