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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502700618
Report Date: 03/03/2025
Date Signed: 03/04/2025 09:47:29 AM

Document Has Been Signed on 03/04/2025 09:47 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:MAR-RIC CARE HOMEFACILITY NUMBER:
502700618
ADMINISTRATOR/
DIRECTOR:		WEST, MARISSAFACILITY TYPE:
735
ADDRESS:2749 LINDBROOK DRTELEPHONE:
(209) 869-2848
CITY:RIVERBANKSTATE: CAZIP CODE:
95367
CAPACITY: 38CENSUS: 38DATE:
03/03/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Michael TalbotTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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Unannounced case management visit made out to this facility on 03/03/2025 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility representative, Michael Talbot, who was briefly interviewed at this time.
Current census was 38 residents.
The purpose of today's case management visit was to follow up on an incident that took place in the early part of February 2025 involving a resident, R1, who left the facility without properly signing out and missing the required time for medications.
A review of the forms and documents for R1 was conducted. A review of the resident, R1's, LIC 602 was conducted.
It was observed that R1 was deemed to be able to leave this facility unassisted without any supervision at this time. This LIC 602 was last updated on 07/24/2024.

There were no deficiencies observed or cited during today's case management visit.

Exit Interview
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 03/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/03/2025
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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