<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604122
Report Date: 07/03/2024
Date Signed: 07/03/2024 10:41:23 AM

Document Has Been Signed on 07/03/2024 10:41 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:
07/03/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:56 AM
MET WITH:Program Administrator Elizabeth GauciTIME VISIT/
INSPECTION COMPLETED:
10:55 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 7/3/24 at 8:56am Licensing Program Analyst (LPA) Javina George conducted an unannounced Required 1-Year visit/annual inspection. LPA met with the Program Administrator Elizabeth Gauci, where LPA explained the purpose of the visit. The facility is licensed to serve age 18 through 59, 4 non ambulatory only. The facility is approved for delayed egress for the front and east side yard gates. At the time of the visit there were six (6) staff, and four (4) clients present. Below is a summary of observations made during today’s visit:

The facility is a single- story home consisting of 4 bedrooms and 3 bathrooms, living room, backyard. There are plenty of activities to encourage socialization. The facility was observed to be clean and clutter free. The passageways are free from obstruction. There are no pools or bodies of water on the premises.

The facility uses Electronic-Medication Authorization Records (MAR). The medications stored in a medication cart inside the locked medication room. Records review the clients files were observed to have the required documents such as Admissions agreement, and medical assessment. Staff files all staff present were observed to have criminal records clearance and to be associated to the facility. In addition, all staff possess current First Aid/CPR certification. The Program Administrator possesses a valid administrator certificate which expires on 4/20/25. The facility conducts drills on a monthly basis and the last disaster drill was on 6/29/24.

Please note that interviews with both clients and staff were unable to be conducted as Client# 4(C4) was having a behavior throughout LPAs visit.

There were no deficiencies observed during today’s visit.

An exit interview was conducted with Program Administrator Elizabeth Gauci and a copy of this report was reviewed and provided to Elizabeth Gauci Program Administrator.

SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE: DATE: 07/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/03/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1