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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455920054
Report Date: 12/27/2023
Date Signed: 12/27/2023 12:10:28 PM

Document Has Been Signed on 12/27/2023 12:10 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 ALTURASFACILITY NUMBER:
455920054
ADMINISTRATOR:BATES, DAMEYAFACILITY TYPE:
735
ADDRESS:20785 OLD ALTURAS ROADTELEPHONE:
(530) 222-5633
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY: 5CENSUS: 5DATE:
12/27/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Dameya Bates AdministratorTIME COMPLETED:
12:15 PM
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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 Dameya Bates. This is a Change of Ownership pre-licensing, there are currently five (5) residents living in the home.

LPA's toured the facility inside and out to ensure the health and safety of residents and staff present. LPA's evaluated the facility based upon the Adult Residential Facility Pre-Licensing Self Certification worksheet.

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.

Based on observation and interview it appears the facility is ready to be licensed. LPA Benson will contact Central Application Unit about this inspection.

Requirements for pre-licensing inspection met.

LPA notes, no deficiencies.

Exit interview, 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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