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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397005503
Report Date: 10/13/2023
Date Signed: 10/13/2023 11:19:03 AM

Document Has Been Signed on 10/13/2023 11:19 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:MARYANN PATACSIL'S CARE HOME #2FACILITY NUMBER:
397005503
ADMINISTRATOR:MARYANN PATACSILFACILITY TYPE:
735
ADDRESS:335 PRADO WAYTELEPHONE:
(209) 477-4915
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY: 6CENSUS: 4DATE:
10/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Maryann Patacsil - AdministratorTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced Required 1 Year Annual Inspection Visit. LPA met with the direct care staff and explained the purpose of the visit.

LPA and direct care staff inspected the physical plant including but not limited kitchen, dining room, living room, three resident bedrooms, garage and grounds of the facility to ensure compliance with Title 22 regulations. The facility is a single story structure with three double occupancy rooms for residents and a live in staff bedroom. The facility was observed to be sanitary and free of odor. The facility was equipped with adequate furniture and lighting for the six clients. No obstructions to fire exits noted. Facility has a separate living room and family room with dining area off the kitchen.

The facility submitted a LIC 808 mitigation plan, which was approved. Water temperature reads 111.5*F in the kitchen sink which meets the 105-120 degree Fahrenheit regulation. and room temperature reads 74*F. LPA observed the facility to have adequate food supply. Resident rooms were sanitary and had the required furniture and furnishings. The facility common areas were clean and furnished. Smoke and carbon detectors were in good repair. Fire extinguishers were last inspected on March 9, 2023. Facility has an emergency food and water kit.

LPA reviewed three staff and two resident files that were locked and readily available for review. Staff had current First Aid/CPR certificates All staff have criminal record clearance and are associated to the facility.

LPA received the following updated documents on today's date: LIC 308 Designation of Responsibility, administrator certificate, and copy of surety bond.

Per the California Code of Regulations, Title 22 no deficiencies were observed or cited. 

Exit interview held with direct care staff. A report and LIC 811 (Confidential Names) was left at the facility
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Ruth Wallace
LICENSING EVALUATOR SIGNATURE: DATE: 10/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/13/2023
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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