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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455002818
Report Date: 07/09/2024
Date Signed: 07/09/2024 01:56:27 PM

Document Has Been Signed on 07/09/2024 01:56 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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:MERAKEY - OLD 44FACILITY NUMBER:
455002818
ADMINISTRATOR/
DIRECTOR:		SHAW, NATALIEFACILITY TYPE:
738
ADDRESS:21345 OLD 44 ROADTELEPHONE:
(530) 768-7336
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY: 4CENSUS: 4DATE:
07/09/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Program Administrator, Natalie ShawTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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On July 9, 2024 at approximately 01:15 PM, Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at Merakey - Old 44 for the purpose of conducting a Case Management-Incident Inspection. Upon arrival, LPA was greeted at the door by Program Administrator, Natalie Shaw, and was granted access into the facility.

During this Case Management-Incident Inspection, LPA interviewed the Administrator and reviewed the Clients IPP. Client was unavailable for an interview due to sleeping.

No deficiencies were observed or cited during today's Case Management-Incident inspection. Exit interview was conducted, and a copy of this report was emailed to the Administrator due to printer issues.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE: DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/09/2024
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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