079200618-9-4-2024-15-AS-HHUL-DA4SNU-20241016140208

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200618
Report Date: 09/04/2024
Date Signed: 09/04/2024 12:56:58 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 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
08/29/2024 and conducted by Evaluator Tonica Syess-Gibson

COMPLAINT CONTROL NUMBER: 15-AS-20240829105836

FACILITY NAME:	MACRI'S ADULT RESIDENTIAL FACILITY		FACILITY NUMBER:	079200618
ADMINISTRATOR:	USANA, JEREMY N		FACILITY TYPE:	737
ADDRESS:	4680 NEROLY ROAD		TELEPHONE:	(925) 679-4430
CITY:	OAKLEY	STATE: CA	ZIP CODE:	94561
CAPACITY:	4	CENSUS: 4	DATE:	09/04/2024
		UNANNOUNCED	TIME BEGAN:	12:43 PM
MET WITH:	Jeremy Usana, Administrator		TIME COMPLETED:	01:06 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are not ensuring that resident's are adequately fed while in care.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 09/04/2024 at 12:51PM, Licensing Program Analysts (LPAs) T. Syess-Gibson and David Doidge arrived to conduct a complaint investigation. LPAs met with Jeremy Usana, Administrator and explained the purpose of the visit.

LPAs interviewed staff and obtained the following documents: Physician Reports, and weekly meal menu. LPAs observed there is a minimum of 7-day non-perishables and 2-day perishables foods for clients in care. During interview S1 informed LPAs two (2) of the four (4) clients are on special diets per doctors orders.

Based on interviews conducted and observations made, and while the allegation may be valid, there is not a preponderance of evidence to prove the alleged violations did, or did not, occur. Therefore, the allegation is UNSUBSTANTIATED.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE:	DATE: 09/04/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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