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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502700618
Report Date: 11/04/2024
Date Signed: 11/05/2024 08:55:58 AM

Document Has Been Signed on 11/05/2024 08:55 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:MAR-RIC CARE HOMEFACILITY NUMBER:
502700618
ADMINISTRATOR/
DIRECTOR:		WEST, MARISSAFACILITY TYPE:
735
ADDRESS:2749 LINDBROOK DRTELEPHONE:
(209) 869-2848
CITY:RIVERBANKSTATE: CAZIP CODE:
95367
CAPACITY: 38CENSUS: 37DATE:
11/04/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Marissa WestTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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Unannounced case management visit conducted on 11/04/2024 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator, Marissa West, who was briefly interviewed at this time.
Current census was 37 residents.
The purpose of this case management visit was to follow up and inquire about recent incident reports in regards to facility residents and their related care.
An interview was conducted with the facility designated Administrator Marissa West in regards to these incident reports involving recent Absence Without Leave (AWOL) incidents at this time.
It was learned that this facility was following all of the policies and procedures outlined in their plan of operation. In addition, this facility, and it's representatives, were making the appropriate calls and notifying all involved entities when these incidents took place.

There were no deficiencies observed or cited during today's case management visit.

Exit Interview
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 11/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2024
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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