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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 015600255
Report Date: 01/05/2026
Date Signed: 03/03/2026 11:21:36 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/29/2025 and conducted by Evaluator Kelly Nguyen
COMPLAINT CONTROL NUMBER: 15-AS-20251229172122
FACILITY NAME:MERCY RETIREMENT & CARE CENTERFACILITY NUMBER:
015600255
ADMINISTRATOR:MCCARRON, KATHLEENFACILITY TYPE:
741
ADDRESS:3431 FOOTHILL BOULEVARDTELEPHONE:
(510) 534-8540
CITY:OAKLANDSTATE: CAZIP CODE:
94601
CAPACITY:160CENSUS: 80DATE:
01/05/2026
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Kathleen Mccarron, Administrator TIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Residents sustain unexplained injury while in care
INVESTIGATION FINDINGS:
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*****THIS IS AN AMENDED REPORT FROM VISIT 1/05/2026*****

On 01/05/2026 at 9:45 AM, Licensing Program Analysts (LPAs) K. Nguyen and A. Christy arrived unannounced to conduct 10-day initial complaints and to deliver findings in regard to the allegation above. LPA met with Kathleen McCarron, Administrator, and explained the purpose of the visit.

During the course of the investigation, LPAs conducted interviews and reviewed residents’ records, including but not limited to the resident’s staff roster, physician report, admission agreement, medication list, and after summary visit from dated Aug 2025 to Dec 2025. R1 was admitted to the facility on 2/1/25 till present.

Report continues on LIC 9099c…
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 01/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 15-AS-20251229172122
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: MERCY RETIREMENT & CARE CENTER
FACILITY NUMBER: 015600255
VISIT DATE: 01/05/2026
NARRATIVE
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***report continues from LIC9099***

Review of R1’s medical records documents that R1 sustained approximately 8 falls once a month, resulting in multiple injuries and at least 8 hospital visits. Also documented in R1’s medical records were that R1 was a fall risk, however after reviewing R1 care plan shows fall injuries were counted for and the facility does have a fall intervention in place including but not limited to frequent check in every two hours, clutter free, assistive devices are available in good repair, the bed in low position, half bed rails and with soft matting around the bed. According to the SOC 341 obtained by the department, RP stated that the hospital staff found R1 on the hospital floor. R1 was sent out on 11/28/2025 by the facility via ambulance with an unwellness fall, and it was determined that any fall R1 experiences needs to be sent to the hospital due to R1's care plan. Before sending out, R1 was assessed, and the record shows that R1 did not have any injuries, but due to R1's conditions. The facility followed procedure and called 911 to transport R1 to the hospital, and informed the family member that R1 was sent out.

LPAs interviewed S1, S2, S3, and S4; all confirmed that they did carry out the care prevention plan for R1.

This agency has investigated the complaint alleging residents sustain unexplained injury while in care. We have found that the complaint was unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted, a copy of this report provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 01/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2