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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 515002770
Report Date: 06/14/2024
Date Signed: 06/14/2024 02:45:55 PM

Document Has Been Signed on 06/14/2024 02:45 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, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
FACILITY NAME:MERAKEY - FRANKLINFACILITY NUMBER:
515002770
ADMINISTRATOR/
DIRECTOR:		AGEE, KENNETHFACILITY TYPE:
737
ADDRESS:2888 FRANKLIN ROADTELEPHONE:
(760) 571-0953
CITY:YUBA CITYSTATE: CAZIP CODE:
95993
CAPACITY: 4CENSUS: 2DATE:
06/14/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Kenneth Agee, AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Bethany Mirlohi and Cheyenne Ratajczak arrived to conduct a case management visit.

On June 14, 2024, the Department was informed by the Regional Center that on June 13, 2024, the Regional Center received a report from the licensee that the facility's well water tested and found with trace amounts of cholera bacteria, necessitating the immediate relocation of residents by the Regional Center and an emergency water shut-off. The facility safely relocated two (2) residents to a nearby hotel. No illnesses or other negative impacts have been reported.

LPA's toured the rooms clients are staying in and observed it to be clean, safe, and sanitary. Resident's had personal belongings, medications properly stored, and sufficient food.

No deficiencies cited during today's visit. Exit interview conducted and report provided.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Bethany Mirlohi
LICENSING EVALUATOR SIGNATURE: DATE: 06/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/14/2024
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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