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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
515002770
Report Date:
01/10/2024
Date Signed:
01/10/2024 02:43:46 PM
Document Has Been Signed on
01/10/2024 02:43 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:
01/10/2024
TYPE OF VISIT:
Case Management - Incident
UNANNOUNCED
TIME BEGAN:
01:00 PM
MET WITH:
Erin Duchene
TIME COMPLETED:
02:50 PM
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LPA Hiratsuka conducted this unannounced case management visit in response to an incident that occurred on 12/31/2023. LPA spoke to Lead II Staff Erin Duchene.
LPA interviewed two of the residents here and a couple of staff. LPA also requested some more information to be sent over.
No deficiencies cited.
SUPERVISORS NAME
:
Troy Ordonez
LICENSING EVALUATOR NAME
:
Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE
:
DATE:
01/10/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
01/10/2024
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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