<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701028
Report Date: 07/28/2022
Date Signed: 07/28/2022 09:50:13 AM

Document Has Been Signed on 07/28/2022 09:50 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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:MKS QUALITY CARE LLCFACILITY NUMBER:
342701028
ADMINISTRATOR:LEE, KEVINFACILITY TYPE:
740
ADDRESS:317 NATOMA ST.TELEPHONE:
(916) 831-7972
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY: 15CENSUS: 10DATE:
07/28/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Elizabeth SwabyTIME COMPLETED:
10:00 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Lavinia Muscan and LPM Laura Munoz, arrived at the facility unannounced on 07/28//2022, to conduct a case management visit. LPAs conducted COVID-19 Precautionary prescreening, and wore surgical masks while at facility. LPAs were screened by Caregiver.

The purpose of today's visit is to ensure room #13 is not being utilized as a sleeping room as this room is not fire cleared for living quarters. Based on today's inspection, room #13 is being used as a office therefore the facility is in compliance with their current fire clearance.

LPM spoke to one of the facility owners during today's visit who stated the licensee would be sending CCL documentation to change the facility Administrator.

Based on today's inspection, no deficiencies were identified.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Lavinia Muscan
LICENSING EVALUATOR SIGNATURE: DATE: 07/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/28/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1