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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
502700618
Report Date:
02/29/2024
Date Signed:
03/05/2024 01:50:02 PM
Document Has Been Signed on
03/05/2024 01:50 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 SOUTH ASC
,
9835 GOETHE ROAD, SUITE 100
SACRAMENTO
,
CA
95827
FACILITY NAME:
MAR-RIC CARE HOME
FACILITY NUMBER:
502700618
ADMINISTRATOR:
WEST, MARISSA
FACILITY TYPE:
735
ADDRESS:
2749 LINDBROOK DR
TELEPHONE:
(209) 869-2848
CITY:
RIVERBANK
STATE:
CA
ZIP CODE:
95367
CAPACITY:
38
CENSUS:
37
DATE:
02/29/2024
TYPE OF VISIT:
POC
UNANNOUNCED
TIME BEGAN:
02:30 PM
MET WITH:
Roberto Ochoa
TIME COMPLETED:
03:30 PM
NARRATIVE
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Unannounced Plan of Correction visit made out to this facility on 02/29/2024 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility designated Administrator Roberto Ochoa. A brief interview was conducted with the facility designated Administrator at this time.
Current census was 37 residents.
The purpose of this visit was to follow up on the deficiencies that were cited from a prior visit conducted on 02/12/2024 and to follow up on the Plan of Correction. The following deficiencies were observed and cited on 02/12/2024:
Staff responsible for providing direct care and supervision shall receive training in first aid from persons qualified by agencies including but not limited to the American Red Cross.
This facility did complete the Plan of Correction and provided all of the required forms and documents at this time.
Plan of Correction clearance letters were printed and copies were provided to the facility designated Administrator at this time.
There were no further deficiencies observed or cited during today's Plan of Correction visit.
Exit Interview
SUPERVISORS NAME
:
Liza King
LICENSING EVALUATOR NAME
:
Charlie Yang
LICENSING EVALUATOR SIGNATURE
:
DATE:
02/29/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
02/29/2024
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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