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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502700618
Report Date: 02/07/2023
Date Signed: 02/10/2023 08:13:19 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 02/10/2023 08:13 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
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) 869-2848
CITY:RIVERBANKSTATE: CAZIP CODE:
95367
CAPACITY: 38CENSUS: 33DATE:
02/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Marisa WestTIME COMPLETED:
12:15 PM
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On 2/23, at approximately 10:00 Am licensing program analysts (LPAs) Maja Jensen and Kimberly Viarella made an unannounced visit to Mar-Ric Care Home to perform an annual inspection. LPAs Jensen and Viarella met with Administrator, Marissa West and explained the purpose of the visit. Marissa holds current Administrator certificate # 6008164735 good through 7/26/23.

The facility has two single story buildings with a single point of entrance. LPAs toured the facility and grounds, including but not limited to reception area, kitchen, dining room, common room, bedrooms, bathrooms, recreation areas, laundry rooms, as well as a staffed medication room.

LPA Jensen observed to the grounds to be clear of debris and all paths were free of obstruction. There are no bodies of water on the premises. The grounds have ample outdoor furniture and space for activities and the facility keeps bicycles for resident use.

The kitchen was observed to have in excess in of 2 days of perishable food and 7 days of non-perishable food. LPAs observed lunch being prepared which consisted of pork chops, mash potatoes, brown gravy and broccoli. All knives, toxins and medications were observed to be locked and inaccessible to residents in care.

The bedrooms were observed to be furnished with dressers, night stands, chairs and tables for the comfort of the residents. The facility temperature was set at 68 degrees which falls within the required regulatory range of 68-85 degrees. The water temperature was measured at 110 degrees which falls within the required regulatory range of 105-120 degrees. The facility keeps an adequate supply of linens on hand. The fire extinguishers were last serviced in September of 2022 and are in compliance. The Ansul system was last serviced in September of 2022 and is in compliance. The first aid kit was observed to be complete with scissors, thermometer, tweezers and first aid manual. Continued on LIC 809C...
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE: DATE: 02/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/07/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 HOME
FACILITY NUMBER: 502700618
VISIT DATE: 02/07/2023
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Continued from LIC 809C...
The carbon monoxide and fire detectors were tested and found to be in good repair. LPA Jensen and Viarella observed postings throughout the facility including but not limited resident rights and COVID mitigation.

LPAs Jensen and Viarella reviewed the staff schedule, daily rounds log and the sign in and sign out log. LPAs also reviewed 2 resident files and 1 staff file. The files were found to be complete.

LPA Jensen requested the LIC 500 and a current copy of the liability insurance to be emailed to maja.jensen@dss.ca.gov by 2/14/23..

The facility was determined to be in substantial compliance.

An exit interview was conducted and a copy of this report was given
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2023
LIC809 (FAS) - (06/04)
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