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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191502401
Report Date: 07/08/2025
Date Signed: 07/08/2025 01:12:26 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/07/2025 and conducted by Evaluator Alberto Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250707082110
FACILITY NAME:MERCI SCHOOLFACILITY NUMBER:
191502401
ADMINISTRATOR:MARTA ESCANUELASFACILITY TYPE:
775
ADDRESS:525 AND 527 NORTH CHANDLERTELEPHONE:
(626) 289-8817
CITY:MONTEREY PARKSTATE: CAZIP CODE:
91754
CAPACITY:145CENSUS: 38DATE:
07/08/2025
UNANNOUNCEDTIME BEGAN:
09:52 AM
MET WITH:Noey Garcia - Associate Director TIME COMPLETED:
01:11 PM
ALLEGATION(S):
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Staff mismanaged resident's medications.
Staff's personnel files are not up to date with staff trainings.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alberto Lopez made an unannounced initial visit investigate the above allegations: LPA met with Administrator Noey Garcia and discussed the purpose of the visit.

The investigation consisted of taking a tour of all day program rooms, Interviewing four (4) staff, four (4) residents, one witness (W1) which is family member, reviewed staff files, C1 face sheet, C1 medication administration record (MAR) record for August 2024, medication for C1, and all training documents for staff.

The investigation revealed regarding Allegation: Staff mismanaged resident's medications. It is alleged that on August 28, 2024, C1 was administered medication late. MAR for August 28, 2024, shows that the medication was administered at 2:46PM instead of the 1:00PM time that C1 doctor has ordered. Staff stated that on that day staff were training at the same time and lost track of time.

(Continued on 9099C)
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2025
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 3
Control Number 28-AS-20250707082110
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: MERCI SCHOOL
FACILITY NUMBER: 191502401
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/08/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/15/2025
Section Cited
CCR
82075(b)(5)(B)
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82075 Health-Related Services (b) Clients shall be assisted as needed with self-administration of prescription and nonprescription medications. (5)If the client's physician has stated in writing that the client is unable to determine his/her own need for nonprescription PRN medication,
but can communicate his/her symptoms clearly, program staff designated by the licensee shall be permitted to assist the client
with self-administration, providing all of the following requirements are met:
(B) Once ordered by the physician the medication is given according to the physician's directions.

This requirement is not met as evidenced by:
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Facility will create a wrtten plan to make sure this error does happen again and send proof to LPA by POC date which is 07/15/2025
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On August 24, 2024, C1 was administered medication at 2:46PM instead of 1:00PM as ordered by doctor which poses a potential risk to health and safety or personal rights of persons in care.
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Type B
07/22/2025
Section Cited
CCR
82075(b)(1)(C)
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82075 Health-Related Services (b) the following requirements are met: Clients shall be assisted as needed with self-administration of prescription and nonprescription medications. (1) Program staff who receive training from a licensed professional, may assist clients with metered-dose inhalers, and dry powder inhalers if

(C) All staff training shall be documented in the facility personnel files.

This requirement is not met as evidenced by:
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Facility director will place copies of all training documentation in staff files and send proof of correction by POC date which is 07/22/2025
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Facility keeps training records in separate binder and has not placed copies in the all the staff personnel files which poses a potential risk to health and safety or personal rights of persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20250707082110
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: MERCI SCHOOL
FACILITY NUMBER: 191502401
VISIT DATE: 07/08/2025
NARRATIVE
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(continued from 9099)

Staff stated that when staff realized the error, staff immediately contacted W1 which is C1 responsible party and W1 asked that C1 be given medication late. W1 stated that C1 doctor provided times at W1 request just to have structure but that C1 doctor assured W1 that taking it outside the window would not have adverse effect on C1. Staff then proceeded to administered C1 medication and sent incident report to regional center. There is enough evidence to substantiate this allegation.

Allegation: Staff's personnel files are not up to date with staff training. It is alleged that staff training is not documented in the staff personnel files. LPA reviewed staff training records, and all staff have completed the required yearly staff training. The staff keeps a separate binder with staff training documentation and some staff files did not have the training documentation in the personnel files during the visit. There is sufficient evidence to substantiate this allegation.

Based on LPA's observations, interviews conducted, records reviewed, the preponderance of evidence standard has been met, therefore the above allegations are found to be substantiated. California Code of Regulations, Title 22, Division 6 Chapters 1 and 6 are being cited on the attached LIC 9099D.




An exit interview was conducted, copy of report, 9099D and appeal rights were issued.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3