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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397005503
Report Date: 01/31/2024
Date Signed: 01/31/2024 12:00:55 PM

Document Has Been Signed on 01/31/2024 12:00 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:MARYANN PATACSIL'S CARE HOME #2FACILITY NUMBER:
397005503
ADMINISTRATOR:MARILYN PATACSILFACILITY TYPE:
735
ADDRESS:335 PRADO WAYTELEPHONE:
(209) 477-4915
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY: 6CENSUS: 3DATE:
01/31/2024
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Marilyn PatacsilTIME COMPLETED:
12:15 PM
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On 1-31-24 at 10:15am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to conduct a quarterly visit. LPA met with Administrator Marilyn Patacsil and explained the purpose of the visit. LPA Bilger inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, living area, common TV area, and outside backyard of the facility to ensure compliance with Title 22 regulations. Facility is an adult residential facility with a current census of 3. Facility has 4 bedrooms and 2 bathrooms. There is a formal living room and family/TV room for residents. All knives, toxins, and other chemicals were inaccessible to residents in care. Resident rights posted. No obstructions to emergency exits noted.

LPA observed facility to be clean and sanitary with no foul odors or disrepair items noted. There was 1 staff on duty during LPA's visit today. LPA reviewed 3 client records. All contents in place. Current behavior plans and Individualized Program Plan (IPP) were observed in all records and up to date. LPA verified training completed by outside vendor on 12-21-23 and included care and supervision procedures with concentration on mealtime risk factors and dietary orders. Risk factors in training included choking, aspiration, and poor food intake. Monthly training on resident dietary orders has also been completed monthly since July 2023.
LPA observed the facility to have adequate food supply during today’s visit. Room temperature was at 69*F. 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 adequate repair. Fire extinguisher is fully charged and dated 3/9/23.

Per California Code of Regulations, Title 22, no deficiencies were observed during this visit. Exit interview was held and a report was given to Administrator Marilyn Patacsil

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2024
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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