247209030-6-1-2023-24-AS-BCHN-CT2MFN-20230622093436

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 247209030
Report Date: 05/24/2023
Date Signed: 06/01/2023 09:21:05 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/15/2023 and conducted by Evaluator David Ayers

COMPLAINT CONTROL NUMBER: 24-AS-20230315152930

FACILITY NAME:	LLC RETIREMENT HOMES I		FACILITY NUMBER:	247209030
ADMINISTRATOR:	LAMERSON, LINDSEY		FACILITY TYPE:	740
ADDRESS:	693 NORTHWOOD DRIVE		TELEPHONE:	(209) 582-2395
CITY:	MERCED	STATE: CA	ZIP CODE:	95348
CAPACITY:	6	CENSUS: 6	DATE:	05/24/2023
		UNANNOUNCED	TIME BEGAN:	10:25 AM
MET WITH:	Lindsey Lamerson - Licensee/Administrator		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Staff mismanage residents' medication
Untrained staff

INVESTIGATION FINDINGS:

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On 3/22/2023, Licensing Program Analyst(LPA) D. Ayers arrived at the facility unannounced to deliver complaint findings. LPA met with Licensee/Administrator Lindsey Lamerson and announced the purpose of the inspection.

During the course of the investigation, the department inspected the facility, conducted interviews, and reviewed records. LPA and licensee reviewed staff training procdeures and Licensee provided records of reuired training for staff. LPA inspected centrally stored medications and medication administratio records(MAR's), and all medications appeared to be administered properly. LPA reviewed physicians' orders for resident medications. The above allegations are unsubstantiated. No deficiencies were cited during the inspection. A copy of the report was provided and exit interview conducted with the licensee.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: David Ayers	TELEPHONE: 559-498-4163
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023

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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