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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502700870
Report Date: 10/24/2024
Date Signed: 10/25/2024 11:04:42 AM

Document Has Been Signed on 10/25/2024 11:04 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:MARGARET'S CARE HOMEFACILITY NUMBER:
502700870
ADMINISTRATOR/
DIRECTOR:
FERIL, MARGARET FFACILITY TYPE:
740
ADDRESS:2208 TEMESCAL DRIVETELEPHONE:
(209) 482-5411
CITY:MODESTOSTATE: CAZIP CODE:
95355
CAPACITY: 6CENSUS: 5DATE:
10/24/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Administrator Margaret FerilTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Jason Lund arrived unannounced to conduct a one year annual/required visit. LPA was greeted by staff and later by Administrator Margaret Feril. LPA Lund explained the reason for the visit. Census: 5
LPA Lund & Administrator Margaret Feril toured/inspected the bathrooms, hot water temperature was measured and observed to be within the required range of 105-120 degrees. A linen closet was located in the hallway and presented a sufficient number of linens to adequately supply and meet the needs of the residents at this time. A inspection of the bedrooms was conducted. Resident furniture was observed to be sufficient to meet their needs at this time. Common areas were inspected, living room, dining area and all other areas intended for resident use were observed to be furnished and maintained in compliance at this time.
A inspection of the garage was conducted. Additional non-perishable food supplies were identified. All cleaning supplies were locked and made inaccessible to residents at this time. The exterior of the physical plant was inspected. Perimeter fence was observed to be stable, and gates were in good repair.
Medication cabinet was identified in the kitchen. Along with the FDR Feril, LPA observed, reviewed, and compared medication to medication dispensing logs. First Aid Kit was present and contained all of the required components. Fire Extinguisher was in compliance and has been services by Hayden Fire Protection on 07/16/2024. LPA reviewed 3 resident files and 2 staff files was in compliance.
No deficiencies were observed and cited on this visit. Exit interview and copy of report was given.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE: DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2024
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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