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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502700870
Report Date: 10/09/2020
Date Signed: 10/09/2020 03:37:03 PM

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:MARGARET'S CARE HOMEFACILITY NUMBER:
502700870
ADMINISTRATOR:FERIL, MARGARET F.FACILITY TYPE:
740
ADDRESS:2208 TEMESCAL DRIVETELEPHONE:
(209) 482-5411
CITY:MODESTOSTATE: CAZIP CODE:
95355
CAPACITY:6CENSUS: 0DATE:
10/09/2020
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Margaret Feril TIME COMPLETED:
01:40 PM
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Licensing Program Analyst Avelina Martinez contacted the facility via telephone to commence a virtual pre-licensing Inspection visit on 10/09/2020 due to COVID-19 and pre-cautionary measures. LPA Martinez identified herself and discussed the purpose of the call and the elements of the pre-licensing visit with Margaret Feril.

The facility has a fire clearance for 6 residents: 1 non-ambulatory resident and 5 ambulatory residents. Margaret will be the administrator of this facility. The facility administrator’s certificate #:6054358740 and expires on: 12/05/2021.  

LPA Martinez conducted a follow up pre-licensing visit. LPA observed all of the following corrections:

  • Fire Drill Log-Licensee created a fire log/manual.
  • Medication storage container for each resident-Licensee now has medication container for each resident.
  • Emergency Kit & Manual-Licensee now has an emergency kit/manual.
  • Mattress protector-All facility beds have a mattress protector.
  • Licensing issue- Facility already licensed to another licensee. Licensing issue corrected.  

The applicant has passed the pre-licensing component of the application process. LPA will notify the Central Application Bureau (CAB) that the pre-licensing has been completed and passed .Exit Interview conducted and 809 report was emailed to the administrator. An electronic email read receipt confirms receiving these documents.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina MartinezTELEPHONE: (916) 263-4809
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2020
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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