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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604122
Report Date: 02/02/2023
Date Signed: 02/02/2023 12:37:31 PM

Document Has Been Signed on 02/02/2023 12:37 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:MERAKEY COLTRANEFACILITY NUMBER:
374604122
ADMINISTRATOR:ROBINSON, MATTHEWFACILITY TYPE:
737
ADDRESS:1927 COLTRANE PLTELEPHONE:
(442) 286-7428
CITY:ESCONDIDOSTATE: CAZIP CODE:
92027
CAPACITY: 4CENSUS: 4DATE:
02/02/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:51 AM
MET WITH:ADMINISTRATOR, MATTHEW ROBINSON.TIME COMPLETED:
12:43 PM
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On February 02, 2023, Licensing Program Analyst (LPA), Venus Mixson arrived unannounced to conduct a case management health and safety visit. LPA Mixson met with Administrator introduced self and explained the purpose of the visit.
LPA Mixson toured the facility and observed corrections made as per DDS's recommendations. LPA Mixson observed one resident in the facility and five caregivers. Administrator stated that three residents are at the day program. There are no imminent health and/or safety concerns observed at the time of visit. LPA Mixson observed no health and/or safety hazards inside the facility. LPA Mixson observed all facility utilities to be on and operating without issue. There was a sufficient amount of staff present at the facility to provide care. LPA Mixson assessed the available food supply and it meets the requirements of two day supply of perishable foods and a seven day supply of non-perishable foods. Medications were found to be in sufficient supply as well.
During the inspection LPA Mixson observed that deep cleaning had been done, the ceiling fans do not have any visible dust, the tables in the dining room were clean and not sticky to touch, laundry room was free of dust, and the microwave replaced as well as the window seal in living room. Photos taken and sent to LPA Mixson and LPM Mullen.
Based on the information obtained during today's visit, there are no immediate threats to the health, safety, and welfare of the residents in care. No deficiencies were cited during today's visit.

An exit interview was conducted and a copy of this report was made available to the Administrator.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE: DATE: 02/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/02/2023
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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