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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003883
Report Date: 12/02/2022
Date Signed: 12/02/2022 01:51:53 PM

Document Has Been Signed on 12/02/2022 01:51 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:MONTEREY, THEFACILITY NUMBER:
347003883
ADMINISTRATOR:DESCARGAR, BERNADETTEFACILITY TYPE:
740
ADDRESS:8700 SECKEL COURTTELEPHONE:
(916) 686-4836
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 6CENSUS: 5DATE:
12/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Maryjane MitchellTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Christina Valerio arrived at the facility unannounced to conduct an annual inspection visit. LPA Valerio was met by facility staff Maryjane Mitchell and explained the purpose of the visit. Administrator Bernadette Descargar and LPA Valerio spoke via cell phone.

LPA evaluated the physical plant to ensure the health and safety of the residents in care. Areas inspected are including but not limited to the kitchen, resident bedrooms; resident bathrooms, living and dining room and outdoor areas. LPA observed the facility to be free of odor, clean and in good repair. LPA observed that all rooms are equipped with the required furniture and sufficient lighting throughout the facility.

LPA measured the water temperature, temperature measured at 112 degrees F, which meets the 105-120 degree Fahrenheit regulation. Temperature inside the facility was observed to be 74 degrees F. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Fire extinguishers and smoke detectors are current and in compliance with fire safety. LPA observed the facility had the required carbon monoxide detectors. First aid kit was checked and is complete. LPA observed centrally stored medications and toxins locked and secure from residents. LPA was sent annual required documents prior to annual inspection.

Per California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies were observed during this visit. An exit interview was held, and a copy of the report was left with facility staff.

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE: DATE: 12/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/02/2022
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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