Facility Evaluation Report

Madison Square Senior Living II, Carmichael02/15/2024Licence 345002940

Capacity6
Census5
Date signed02/15/2024 04:03:25 PM
The inspector’s account

On 2/15/2024, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to conduct a Proof of Correction (POC) visit. LPA met with caregiver, Princess Allen, who notified Supervisor, Samantha Shaw Camacho, who arrived to the facility shortly afterwards.

Today's visit, LPA conducted a file review of two personnel and two staff files. Additionally, LPA conducted an inspection of the kitchen area to ensure there is a secured storage space for sharps.

- §1569.17 Fingerprints and criminal records of individuals in contact with clients; exemptions; criminal records clearances

- 1569.618 Administration and management of residential care facilities; substituted qualifications; employee scheduling

LPA informed Supervisor a copy of POC clearance will be mailed to facility.

LPA and Supervisor discussed Licensee submitting LIC 200 and facility sketch to request fire clearance of six non-ambulatory residents.

No deficiencies cited. Exit interview conducted and a copy of the report will be emailed.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction