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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 557000412
Report Date: 01/30/2025
Date Signed: 01/31/2025 11:39:36 AM

Document Has Been Signed on 01/31/2025 11:39 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:MEADOWVIEW MANORFACILITY NUMBER:
557000412
ADMINISTRATOR/
DIRECTOR:
N/AFACILITY TYPE:
740
ADDRESS:19227 SOUTH COURTTELEPHONE:
(209) 533-0935
CITY:SONORASTATE: CAZIP CODE:
95370
CAPACITY: 20TOTAL ENROLLED CHILDREN: 0CENSUS: 16DATE:
01/30/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Care staff Shyann Leach TIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Jason Lund arrived unannounced at this facility to conduct a one year required visit. LPA Lund met with Care staff Shyann Leach and called Administrator Beatrice Burkett who could not make the visit today. LPA Lund explained the reason for the visit to the Administrator who gave permission for Care staff Shyann Leach to sign the required paperwork. Census: 16
LPA Lund & Care staff Shyann Leach toured/inspected the facility including the interior of the physical plant was toured and observed to be in good condition and sanitary. Fire extinguishers located in the kitchen and hallways appeared to have been annually inspected and is valid until January 6, 2026. LPA observed smoke detectors and carbon monoxide detectors to be operational. The facility also has fire sprinklers. The kitchen area was toured. LPA observed 2- day perishable and 7-day non-perishable foods in the cabinets and refrigerator. Additional perishable food supplies were identified in 2 additional large refrigerators located outside of the kitchen.
LPA observed a locked centralized stored medication cabinet located in the kitchen. First Aid Kit was present and contained all of the required components.
A tour of the resident bathrooms was conducted. Two linen closets were located at the end of each hallway and presented a sufficient number of linens to adequately supply and meet the needs of the residents at this time. A tour of the resident bedrooms was conducted. Resident furniture was observed to be sufficient to meet their needs at this time. Common areas were toured. Living room, dining area and all other areas intended for resident use were observed to be furnished and maintained in compliance at this time. The exterior of the physical plant was toured. LPA Lund observed the outside resident area which appeared to be stable and in good repair.
As a result of this visit, no deficiencies were observed or cited during this annual visit. An exit interview was conducted, and report left.
Lisa RiosTELEPHONE: (916) 969-9685
Jason LundTELEPHONE: (916) 223-6752
DATE: 01/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2025
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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