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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347004351
Report Date: 07/23/2024
Date Signed: 07/23/2024 11:22:06 AM

Document Has Been Signed on 07/23/2024 11:22 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:MAPEL HOUSEFACILITY NUMBER:
347004351
ADMINISTRATOR/
DIRECTOR:		TATEISHI, GARYFACILITY TYPE:
735
ADDRESS:4616 MAPEL LANETELEPHONE:
(916) 962-2199
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 6CENSUS: 5DATE:
07/23/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Gary TateishiTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Melissa Parks arrived on Tuesday July 23, 2024 to conduct the unannounced annual inspection.

During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPA Parks reviewed client (5) and staff (2) files. All client files contained the required paperwork. All staff files contained the required paperwork and training.

LPA Parks and staff Freddie toured the facility together to ensure the health and safety of clients in care. The areas toured included bedrooms (5), kitchen, bathrooms, laundry room, common areas, front and backyard and garage. All chemicals and toxins were kept locked and inaccessible to clients. Fire extinguishers have current inspection tag. Fire drills are conducted monthly. In the areas toured, there were no health or safety violations observed.

No deficiencies cited. Exit interview conducted. A copy of this report was emailed to the Administrator.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE: DATE: 07/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/23/2024
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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