502700618-9-9-2024-27-AS-MBIR-D8XTBU-20240909143543

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 502700618
Report Date: 09/09/2024
Date Signed: 09/09/2024 02:36:29 PM

Document Has Been Signed on 09/09/2024 02:36 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/ DIRECTOR:	WEST, MARISSA		FACILITY TYPE:	735
ADDRESS:	2749 LINDBROOK DR		TELEPHONE:	(209) 869-2848
CITY:	RIVERBANK	STATE: CA	ZIP CODE:	95367
CAPACITY: 38		CENSUS: 38	DATE:	09/09/2024
TYPE OF VISIT:	Case Management - Legal/Non-compliance	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:30 PM
MET WITH:	Jamie Andrade		TIME VISIT/ INSPECTION COMPLETED:	02:30 PM

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A Non-Compliance Conference (NCC) was conducted on 9-9-2024 in the Sacramento South Regional Office via Microsoft Teams. The purpose of this Non-Compliance Conference meeting was to follow up on a previous citation issued to facility . Present in the meeting was Regional Manager (RM) Stephanie Doub, Licensing Program Manager (LPM) Liza King, Licensing Program Analyst (LPA) Michael Bilger, Licensee Jamie Andrade, and Jake Reinhardt representing Licensee. The Non-Compliance Conference process was explained during this meeting to include the Administrative Process.

Topics in this meeting included the following: (1) Care and Supervision (3) Administrator Qualifications and (4) Licensee accountability. RM, LPM and LPA discussed with Licensee the following citations and the associated plans of correction going forward. Please note some citations are under appeal at this time:

On 8/14/2024 a citation was issued under regulation 85078(a)(1) - 85078 - Responsibility for Providing Care and Supervision Based on file reviews and interviews Mar-Ric Care home failed to verify that R2'S Physician’s Report was completed and documented, “able to leave facility unassisted”, resulting in R2 leaving the facility unsupervised, obtaining a dagger and stabbing R1 in the chest

{Cont. on 809C}

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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
	VISIT DATE: 09/09/2024

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On 8/14/2024 a citation was issued under regulation 80064(a)(2) - Administrator - Qualifications and Duties Based on records reviewed the facility failed to create a plan to prevent R2 from bringing items into the facility that could be dangerous.

On 2/12/2024 a citation was issued under regulation 80075(f) - (f) Staff responsible for providing direct care and supervision shall receive training in first aid from persons qualified by agencies. Based on record review, the licensee did not comply with the section cited above in [3] out of [5] facility staff files did not contain updated first aid training.

Licensee agreed to do the following in order to bring the facility into compliance no later than the following dates:

(1) Presence of the administrator at least 40 hours per week (2) updated LIC 500 (3) Licensees plan for monitoring items brought into the facility (4) A written process to ensure documentation is complete and accurate. These are due to the department by COB 09/25/2024. Completing the non-compliance conference does not deprive the Department of its authority to take appropriate formal legal action under the Health and Safety Codes if such action is deemed necessary by the Regional Manager.

In the event that the Department determines that the licensee has violated the law/regulations or is inadequately implementing the approved plans, the Department, in its discretion, may seek formal legal action or other appropriate administrative action. Exit interview was conducted with Licensee and a copy of this report was emailed to Licensee with a request to return with signature by 9-10-2024.

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2024

LIC809 (FAS) - (06/04)

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