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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700102
Report Date: 06/18/2024
Date Signed: 06/18/2024 02:07:17 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 06/18/2024 02:07 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:MELISSA PATACSIL'S CARE HOME 1FACILITY NUMBER:
392700102
ADMINISTRATOR/
DIRECTOR:
PATACSIL, MELISSAFACILITY TYPE:
735
ADDRESS:9082 CHIANTI CIRCLETELEPHONE:
(209) 477-4773
CITY:STOCKTONSTATE: CAZIP CODE:
95212
CAPACITY: 6CENSUS: 4DATE:
06/18/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Melissa Patacsil Marilyn PatacsilTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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On 06/18/2024 Licensing Program Analyst (LPA) Avelina Martinez made an unannounced visit to this facility to conduct an annual required inspection. LPA Martinez met with Melissa Patacsil Marilyn Patacsil and explained the purpose of the visit.

LPA Martinez inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards of the facility to ensure compliance with Title 22 regulations.

Administrator holds current certificate. The facility is licensed for four ambulatory clients and two non-ambulatory. There are currently four clients who reside at this facility.

The LPA Martinez toured the facility with Melissa Patacsil and Marilyn Patacsil on 06/18/2024 at 1:45 PM.

LPA Martinez reviewed four client files and four staff files, and the files were maintained. The facility has an infection control plan and natural disaster plan. The last fire drill was on May 08, 2024. LPA Martinez reviewed two medication administration records (MAR), which were maintained. Fire extinguishers, carbon detectors, and smoke detectors are in good repair. The common areas, bedrooms, bathrooms, kitchen, and laundry areas are furnished and in good repair. The facility has a exterior shaded patio area for resident use. The facility has an adequate food supply. The facility water temperatures measured at 106 degrees, and facility temperature measured at 73 degrees.

Based on this annual inspection, the facility is in compliance with California Code of Regulations, Title 22 and Health and Safety Code, there were no deficiencies cited at this time. An exit interview was conducted, and a copy of this report was provided to the facility.

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Avelina Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/18/2024
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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