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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455920053
Report Date: 12/27/2023
Date Signed: 12/27/2023 10:39:05 AM

Document Has Been Signed on 12/27/2023 10:39 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:MERAKEY - VISTA OAKSFACILITY NUMBER:
455920053
ADMINISTRATOR:RUBIO, CYNTHIAFACILITY TYPE:
734
ADDRESS:4220 VISTA OAKSTELEPHONE:
(530) 222-5633
CITY:REDDINGSTATE: CAZIP CODE:
96002
CAPACITY: 5CENSUS: 5DATE:
12/27/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Cynthia Rubio AdministratorTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Sarah Benson made a Pre-licensing Inspection on today's date of 12/27/2023 and met with Administrator Cynthia Rubio. Administrator certificate is current. This is a Change of Ownership pre-licensing, there are currently five (5) residents living in the home.

LPA toured Physical Plant, Food Service, Common Areas, Bedrooms, Bathrooms, Kitchen, Medication Storage, and Courtyard. Fire extinguishers, smoke detectors, and fire sprinklers were observed. Kitchen was clean and in good repair, LPA observed proper storage area for food. Facility has non-perishable and perishable food supply. Resident bedrooms were checked and were observed to have the required furniture. LPA toured the courtyards to ensure safety. LPA observed locked areas where items such as but not limited to, knives, medication, and toxins are stored inaccessible to residents. Hot water temperature measured within required Title 22 regulations of 105 degrees F and 120 degrees F.

The LPA reviewed resident files, staff files and the facility's Emergency and Disaster Preparedness Binder. The facilities first aid kit is fully stocked and ready for use.

Requirements for pre-licensing inspection met.



LPA notes no deficiencies.



Exit interview preformed and a copy of report given to facility representative.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Sarah Benson
LICENSING EVALUATOR SIGNATURE: DATE: 12/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/27/2023
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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