340312763-12-29-2023-27-AS-CACL-CZ5PZD-20240103104522

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 340312763
Report Date: 12/29/2023
Date Signed: 12/29/2023 02:46:16 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/26/2023 and conducted by Evaluator Kevin Gould

COMPLAINT CONTROL NUMBER: 27-AS-20231226091951

FACILITY NAME:	MERCY MCMAHON TERRACE		FACILITY NUMBER:	340312763
ADMINISTRATOR:	MARY ERICKSON		FACILITY TYPE:	740
ADDRESS:	3865 J STREET		TELEPHONE:	(916) 733-6510
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95816
CAPACITY:	189	CENSUS: 112	DATE:	12/29/2023
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Latrice Ross		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Personal Rights: Staff discarded resident’s personal items without authorization.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kevin Gould conducted an unannounced complaint inspection at Mercy McMahon Terrace on 12/29/23 at 1:30pm to inform the licensee of complaint allegation mentioned above.

Based on the interviews and statements obtained during the investigation process, the allegations cannot be substantiated. LPA conducted interviews with the concerned party (RP) who admitted to moving all items out of the facility prior to her scheduled move out day after providing a 30 day notice to the facility of their intention to move out of the facility. RP states she did return to clean her old room and remove some items from the refrigerator and observed the room had alreadybeen cleaned and had begun to be prepped for a new resident. RP was concerned she would be charged additional fees for cleaning/paining and the return of their alert pendant. RP states she contacted the facility who agreed to prorate the final 30 days and agreed to a refund for the difference to ensure RP's needs were met. RP was satisfied with the outcome and wished to retract the allegation.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Kevin Gould	TELEPHONE: (619) 672-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 12/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2023

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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Control Number 27-AS-20231226091951

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: MERCY MCMAHON TERRACE	FACILITY NUMBER: 340312763
	VISIT DATE: 12/29/2023

NARRATIVE

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The items discarded were a result of a miscommunication between the former resident and the facility. The facility is putting new systems in place to ensure resident belongings that are left behind are retained for a period of time to ensure residents receive all their belongings when leaving the facility.

Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. The Department has determined that the allegations of personal rights are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed.

There are no deficiencies cited per California Code Regulation, TITLE 22.

Exit interview was conducted with the facility administrator. Appeal Rights were issued, and a copy of this report was left at the facility.

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Kevin Gould	TELEPHONE: (619) 672-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 12/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2023

LIC9099 (FAS) - (06/04)

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