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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347000008
Report Date: 06/07/2024
Date Signed: 06/07/2024 04:37:48 PM

Document Has Been Signed on 06/07/2024 04:37 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:MERAKI OF SACRAMENTOFACILITY NUMBER:
347000008
ADMINISTRATOR/
DIRECTOR:		STIR, ANISIA & IOANFACILITY TYPE:
740
ADDRESS:4941 TYLER STREETTELEPHONE:
(916) 348-9316
CITY:SACRAMENTOSTATE: CAZIP CODE:
95841
CAPACITY: 12CENSUS: 9DATE:
06/07/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:45 PM
MET WITH:Samantha TIME VISIT/
INSPECTION COMPLETED:
04:45 PM
NARRATIVE
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On 6/7/24, LPA Kevin Mknelly conducted a plan of correction visit for the citation issued on 5/28/24. LPA met with the house manager and explained the reason for the visit.

The plan of correction has been completed.

When present on 5/28/24, LPA observed and discussed the locking of the facility gates. LPA was not aware of a locked perimeter waiver and fire clearance for locked gates in place.

On 6/6/24, LPA notified Darius Stir via email that a file review was conducted, a locked perimeter waiver was not found and that absent the waiver, the gates may not be locked.

At today's inspection, the gates were again found to be locked.
A regulation violation citation and civil penalties are therefore assessed.

The gates were unlocked while LPA was present.

A copy of this report civil penalties and appeal rights are provided.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE: DATE: 06/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/07/2024
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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Document Has Been Signed on 06/07/2024 04:37 PM - It Cannot Be Edited


Created By: Kevin Mknelly On 06/07/2024 at 04:17 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: MERAKI OF SACRAMENTO
FACILITY NUMBER: 347000008

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/10/2024
Section Cited
CCR
87705(I)(2)

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Care of Persons with Dementia(l) The following initial and continuing requirements shall be met for the licensee to lock exterior doors or perimeter fence gates:(2) The licensee shall ensure that the fire clearance includes approval of locked exterior doors or locked perimeter fence gates.
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By the POC date of 6/10/24, Licensee will submit a a plan for staffing to address resident wandering and exit seeking behaviors as well as a waiver request if they wish to pursue the necessary clearance for a locked perimeter (See 87705(I) for waiver requirements).
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This requirement was not met based on obervations by LPA on 5/28/24 and 6/7/24.
This posed an immediate risk to residents.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Maribeth Senty
LICENSING EVALUATOR NAME:Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:
DATE: 06/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/07/2024


LIC809 (FAS) - (06/04)
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