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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 515002770
Report Date: 06/26/2024
Date Signed: 06/26/2024 10:46:25 AM

Document Has Been Signed on 06/26/2024 10:46 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, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
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:
06/26/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:27 AM
MET WITH:Erin WesleyTIME VISIT/
INSPECTION COMPLETED:
10:50 AM
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Licensing Program Analyst (LPA) Hiratsuka conducted this unannounced case management visit.

This visit in response to the residents temporarily moving out from June 13, 2024, due to the well for the water testing with something that was a potential hazard to the occupants of the facility. The residents temporarily relocated to a hotel during the clean-up. The residents moved back to the facility on June 20, 2024.

LPA interviewed one resident who was present today and the resident stated they are fine. The other resident went out on an outing when LPA arrived.

No deficiencies cited.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE: DATE: 06/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/26/2024
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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