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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604122
Report Date: 07/18/2023
Date Signed: 07/25/2023 10:26:13 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 07/25/2023 10:26 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
RIVERSIDE AC/SC, 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:
07/18/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
09:48 AM
MET WITH:Dominick AltadonnaTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Cheryl Goodrich conducted an unannounced Required 1-Year visit. LPA met with the Program Administrator Dominick Altadonna at the garage and was granted entry. The purpose of today’s visit is to inspect the facility to ensure that the facility follows California Code of Regulations, Title 22, Division 6. Facility is approved for four (4) ambulatory residents. The Facility is approved for delayed egress.
Physical Plant: front entrance, interior and surrounding exterior were clean and in good repair with no pathway obstruction; doorway alarms were in working order; facility temperature read at 68 degrees; residents' main restroom water temperature read at 112.5 degrees; there were no bodies of water on premises; there was sufficient lighting and mattress pads in all the residents' bedrooms; fire alarm and smoke carbon monoxide detectors were in working order. Facility does not house firearms and/or ammunition on grounds.
Infection Control Plan: The facility has an approved infection control plan that outlines handwashing procedures, handling of residents and bodily fluids and disposal of such items. The facility last updated their infection control plan on January 3, 2023.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Cheryl Goodrich
LICENSING EVALUATOR SIGNATURE: DATE: 07/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/18/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: MERAKEY COLTRANE
FACILITY NUMBER: 374604122
VISIT DATE: 07/18/2023
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Food Services: 7-day non-perishable and 2 day of perishable food supply was observed, and all food was properly stored and available to residents. An emergency food supply was observed for staff and residents. The facility had 2 refrigerators one in the house and one in the primary garage with an additional top open freezer.
Medication/Facility Records: Medications were observed to be labeled and in a locked place that is inaccessible to residents. All staff subject to a criminal record review obtained fingerprint clearance and/or an exemption. Staff responsible for direct care and supervision have current First Aid / CPR training. Program Administrator has completed a written admission agreement, current medical assessment and needs and service plan with each resident. Exceptions & waivers are in place and meet said terms. The Program Director handles the resident’s cash resources and has a resource documentation log with cash, receipts and entries consisting of resident’s spending. Last disaster drill was held on 07/05/23.
Summary: Based on today's visit, no deficiencies were observed at this time. An exit interview was conducted with Program Administrator Dominick Altadonna, and a copy of this report was printed Signature below confirms receipt of these rights.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Cheryl Goodrich
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023
LIC809 (FAS) - (06/04)
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