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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 515002770
Report Date: 06/05/2023
Date Signed: 06/06/2023 11:02:30 AM

Document Has Been Signed on 06/06/2023 11:02 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 NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
FACILITY NAME:MERAKEY - FRANKLINFACILITY NUMBER:
515002770
ADMINISTRATOR:RODRIGUEZ, VANESSAFACILITY TYPE:
737
ADDRESS:2888 FRANKLIN ROADTELEPHONE:
(760) 571-0953
CITY:YUBA CITYSTATE: CAZIP CODE:
95993
CAPACITY: 4CENSUS: 2DATE:
06/05/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Vanessa Rodriguez, AdministratorTIME COMPLETED:
01:00 PM
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On 6/5/2023 LPA Tryon visited the facility to do an annual visit using the CARE Tool. LPA met with Administrator Vanessa Rodriguez. There are currently 2 residents living at the facility.
LPA toured the facility with Ms. Rodriguez including kitchen, common areas, bedrooms, bathrooms, hallways, laundry room, storage areas, back yard, office. The facility appears to be clean, well-furnished and in very good condition. There is a large back yard with plenty of space for residents to walk/exercise. Residents all have individual rooms.
Food supplies are appropriate to meet the requirement of 2 days perishable and 7 days non-perishable food. Facility has good supply of other items such as cleaners, personal hygiene products, PPE, household supplies, etc.
LPA reviewed the CARE Tool with Ms. Rodriguez.
LPA reviewed 3 staff files and one resident file. Staff files include appropriate required training hours, clearances, physician reports, etc.
Resident files include admission agreements, pre-placement evaluations, IPPs, Restricted Health Condition Care Plans, physician reports, etc.
Medications are centrally stored and locked,
LPA interviewed one resident and one staff person.

At this time, the facility appears to be in substantial compliance with the regulations. No deficiencies were cited at this visit. Exit interview conducted.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Todd Tryon
LICENSING EVALUATOR SIGNATURE: DATE: 06/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/05/2023
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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