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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502700618
Report Date: 02/17/2022
Date Signed: 02/17/2022 12:59:30 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 02/17/2022 12:59 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:MAR-RIC CARE HOMEFACILITY NUMBER:
502700618
ADMINISTRATOR:WEST, MARISSAFACILITY TYPE:
735
ADDRESS:2749 LINDBROOK DRTELEPHONE:
(209) 531-3562
CITY:RIVERBANKSTATE: CAZIP CODE:
95367
CAPACITY: 38CENSUS: 34DATE:
02/17/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Marissa WestTIME COMPLETED:
01:15 PM
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On 02/17/2022 at 10:00 am Licensing Program Analysts (LPAs) Maja Jensen and Avelina Martinez arrived unannounced to conduct a Required 1-year Annual inspection. LPAs met with Administrator Marissa West and was allowed entry into the facility that is licensed to serve a total capacity of 38, today's census is 34. All staff observed on site with criminal record clearance in Licensing Information System.

The physical plant was toured inside and outside. LPAs observed kitchen, dining hall, restrooms, 4 bedrooms, storage areas, and common living areas to be clean and in good repair. All bedrooms are double occupancy. The temperature inside the facility was 69*F which is within the required range of 68*F and 85*F. The hot water was measured in one bathroom and was 115.7 which falls within regulatory range of between 105*F and 120*F. LPAs observed the centrally stored medications, toxins and knives to be locked inaccessible to residents. The LPAs observed three first aid kits which were in compliance. The files of two residents and two staff members were observed and were determined to be complete and updated. There was a food supply that was in excess of 7 days of perishable food and 2 days of non-perishable foods. LPAs observed fresh fruit and vegetables stored in the pantry. Lunch service was observed and accurately reflected the offerings as posted on the menu visible by residents. Medication administration was observed and in compliance with regulations. All required COVID signage was posted at the facility main entry point with screening procedures in place. Resident rights information was posted in a prominent area in the facility. The exterior of the facility was found to be clear of obstruction and well maintained.

Per California Code of Regulations (CCRs) - Title 22, no deficiencies observed or cited. Exit interview held and a copy of report provided.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Avelina Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 02/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/17/2022
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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