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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502700618
Report Date: 07/11/2023
Date Signed: 07/11/2023 12:27:21 PM

Document Has Been Signed on 07/11/2023 12:27 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) 869-2848
CITY:RIVERBANKSTATE: CAZIP CODE:
95367
CAPACITY: 38CENSUS: 37DATE:
07/11/2023
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:Marissa WestTIME COMPLETED:
12:40 PM
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On 7/11/23 Licensing Program Analyst (LPA) Maja Jensen conducted a case management visit to the facility for the purpose of delivering an Order to Licensee/Facility of Immediate Exclusion From Facility. LPA Jensen met with Licensee Marissa West and explained the purpose of today's visit.

LPA Jensen handed the Order to Licensee/Facility of Immediate Exclusion From Facility letter to Marissa West and explained that staff (S1) is excluded from any involvement in the facility effective immediately. Marissa West confirmed S1 was terminated in April of 2023.

LPA handed the Order To Individual of Immediate Exclusion from all facilities to staff.

No citations were issued on today's date. A copy of this report, the Declaration of Service, LIC 811 and appeal rights were provided to the Administrator.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE: DATE: 07/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/11/2023
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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