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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
515002770
Report Date:
10/11/2023
Date Signed:
10/11/2023 04:22:52 PM
Document Has Been Signed on
10/11/2023 04:22 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 NORTH ASC
,
9835 GOETHE ROAD, SUITE 100
SACRAMENTO
,
CA
95827
FACILITY NAME:
MERAKEY - FRANKLIN
FACILITY NUMBER:
515002770
ADMINISTRATOR:
AGEE, KENNETH
FACILITY TYPE:
737
ADDRESS:
2888 FRANKLIN ROAD
TELEPHONE:
(760) 571-0953
CITY:
YUBA CITY
STATE:
CA
ZIP CODE:
95993
CAPACITY:
4
CENSUS:
2
DATE:
10/11/2023
TYPE OF VISIT:
Case Management - Incident
UNANNOUNCED
TIME BEGAN:
03:00 PM
MET WITH:
Erin Duchene
TIME COMPLETED:
04:30 PM
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LPA Hiratsuka conducted this unannounced case management visit in response to incident reports submitted by this facility in September up to current as well as one former resident. LPA spoke to Lead II Staff Erin Duchene.
LPA and Mr. Duchene discussed several incidents and suggestions by LPA for documentation.
No deficiencies cited.
SUPERVISORS NAME
:
Troy Ordonez
LICENSING EVALUATOR NAME
:
Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE
:
DATE:
10/11/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/11/2023
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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