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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003596
Report Date: 10/24/2022
Date Signed: 10/24/2022 10:01:35 AM

Document Has Been Signed on 10/24/2022 10:01 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:MARSEILLE BOARD AND CAREFACILITY NUMBER:
347003596
ADMINISTRATOR:NEAL, GLORIAFACILITY TYPE:
735
ADDRESS:4137 MARSEILLE CTTELEPHONE:
(916) 421-1623
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY: 6CENSUS: 4DATE:
10/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Patricia Rodriguez - Direct Care GiverTIME COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced Required 1 Year Annual Inspection Visit. LPA met with met with caregiver and explained purpose of visit.

During today's inspection, 3 clients were home and 2 staff were on duty. This facility operates as a level 4I home vendorized by Alta California Regional Center. The interior and the exterior of the facility were inspected including the common living spaces, resident bedrooms and bathrooms, and kitchen. Bathrooms and bedrooms were clean and in good repair. There is a locked storage for medications and toxins. Food supply is adequate for 2 day perishable and 7 day nonperishable. Fire extinguishers were inspected 2/28/22. Smoke alarms were checked and in found in good working order. Fire drills are conducted as required. Carbon Monoxide detector was found in good working order. The hot water temperature was measured 108.4*F which is within the required range of 105-120*F. LPA observed a sufficient amount of towels and linens. This facility is operating within the scope of their license.

LPA reviewed two (2) resident and three (3) staff records. Resident files were found to be complete and current. A review of staff records indicates that all facility staff have received criminal record clearances and/or are associated to this facility. Staff records reviewed indicated current first aid certificates. Facility is conducted staff training as required.

Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no violations were observed during this visit. Exit interview held with house manager and a copy of report given.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Ruth Wallace
LICENSING EVALUATOR SIGNATURE: DATE: 10/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2022
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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