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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604122
Report Date: 06/14/2024
Date Signed: 06/14/2024 11:20:27 AM

Document Has Been Signed on 06/14/2024 11:20 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 ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:MERAKEY COLTRANEFACILITY NUMBER:
374604122
ADMINISTRATOR/
DIRECTOR:		CARLY ADAMSFACILITY TYPE:
737
ADDRESS:1927 COLTRANE PLTELEPHONE:
(442) 286-7428
CITY:ESCONDIDOSTATE: CAZIP CODE:
92027
CAPACITY: 4CENSUS: 4DATE:
06/14/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:50 AM
MET WITH:Administrator, Carly AdamsTIME VISIT/
INSPECTION COMPLETED:
11:25 AM
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On 6/14/2024, Licensing Program Analyst (LPA), Janette Romero arrived unannounced to the facility to conduct a case management visit regarding Client 1 (C1). LPA met with Administrator, Carly Adams who was informed of the purpose of the visit.

During the visit, LPA toured the facility, conducted interviews, and obtained records. During the tour LPA observed clients in their rooms and common areas. The facility has working utilities and the required food supply for the clients in care. During today's visit, LPA did not observe any imminent health or safety concerns. An exit interview was conducted where a copy of this report was reviewed and provided to Administrator Adams.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE: DATE: 06/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/14/2024
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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