340312763-5-26-2022-27-AS-KHOS-CF8JHK-20220609070404

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 340312763
Report Date: 05/26/2022
Date Signed: 05/26/2022 10:58:12 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/21/2022 and conducted by Evaluator Avelina Martinez

COMPLAINT CONTROL NUMBER: 27-AS-20220321144019

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: 105	DATE:	05/26/2022
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Mary Erickson		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Residents are being locked out of the facility due to being short staff.

INVESTIGATION FINDINGS:

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On 05-26-2022 at 8:30 am, Licensing Program Analyst (LPA) Avelina Martinez conducted an unannounced facility visit in regards to a complaint investigation with the above allegation. LPA met with Mary Erickson and explained the purpose of today's visit.

Throughout the investigation, LPA Martinez conducted interviews and toured the facility. LPA Martinez was informed by staff and residents that there were no issues with leaving the facility and reentering the facility. In addition, residents can inform their caregivers that they are leaving the facility, and to meet them at the front lobby at a certain time (upon return). Moreover, residents who leave the facility to sit at the front sitting area can push their pendent buttons when they are ready to reenter the facility, and a caregiver will escort them to their rooms.

Continued...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina Martinez	TELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:	DATE: 05/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2022

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-20220321144019

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: MERCY MCMAHON TERRACE	FACILITY NUMBER: 340312763
	VISIT DATE: 05/26/2022

NARRATIVE

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Furthermore, for a temporary time period on Sundays, anyone wanting to enter the facility would have to call the main line. This would happen during the following time frames: 10:00 AM to 10:15 AM; 12:30 PM to 1:00 PM; and 2:30 PM to 2:45 PM. During these time frames, a facility staff would let visitors or residents in the facility.

As a result of the gathered investigation information, the facility had staff to let residents and visitors in the facility on Sundays. As of today April 2022, visitors and residents no longer have to call the facility on Sundays at the following times: 10:00 AM to 10:15 AM; 12:30 PM to 1:00 PM; and 2:30 PM to 2:45 PM to enter the facility.

Additionally, LPA Martinez toured the memory care unit. LPA Martinez tested the memory care door bells, and timed how long it would take for a caregiver to respond to the door bell ring. The average wait time was one minuet. Due to Covid-19 screening policies, residents' family members are no longer able to use a code to enter the memory care unit. The facility staff is responsible for ensuring that Covid-19 screening policies are being implemented and to ensure all visitors are being screened. In addition, door code policies have been changed for security and safety purposes.

Due to the above noted information, 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, and therefore the allegation is unsubstantiated.

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina Martinez	TELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:	DATE: 05/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2022

LIC9099 (FAS) - (06/04)

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