<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700650
Report Date: 08/03/2023
Date Signed: 08/04/2023 09:20:30 AM

Document Has Been Signed on 08/04/2023 09:20 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:MERAKEY - PARKSFACILITY NUMBER:
342700650
ADMINISTRATOR:KYRIE S RICHARDSONFACILITY TYPE:
737
ADDRESS:3333 PARKS LANETELEPHONE:
(916) 609-2426
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 4CENSUS: 4DATE:
08/03/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:Kyrie Richardson, AdministratorTIME COMPLETED:
04:35 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Angela Hood arrived at the care home unannounced to conduct a case management inspection related to incident reports received by the Department.

On 7/23/23, an incident report was received regarding an AWOL. On 7/21/23, client (C1) refused medication and went to their room. Care staff checked on C1 at approximately 9pm and found client in their room. Staff checked again at 10:40pm and found C1 missing having left through their bedroom window. Law enforcement was notified. Staff located C1 at a nearby store at 11:20pm. C1 returned with staff at 12:50pm.

On 7/22/23, an incident was reported that occurred with C1. C1 did not want to be at the facility. Staff offered C1 to go on an outing. C1 became destructive to facility property and throwing objects at staff. Law enforcement was contacted and was able to de-escalate the situations. After law enforcement left, C1 began engaging in property destruction again. C1 started a fire using the stove to light cleaning rags. Staff used the fire extinguisher to put out the fire and contacted law enforcement. C1 engaged in aggression towards law enforcement officers and was taken to a mental health treatment center.

On 7/31/23, an incident report was received regarding C1 refusing medication. On 7/30/23, C1 refused to take 2 medications at approximately 12:50pm. The facility consulted with nursing and were advised to monitor C1 throughout the day for any adverse symptoms.

During today's visit, LPA toured the facility and participated in a meeting with the facility and stakeholders. Since C1 has returned to the facility from the mental health treatment center, there have been no further issues with AWOL. C1 has not been destructive to facility property, however, has been verbally aggressive at times to staff members. Administrator indicated that C1 hasn't refused medication during every medication pass and has not caused any adverse symptoms for C1.

There are no deficiencies noted during today's inspection. Exit interview was conducted. Copy of report emailed to facility as computer was having technical issues.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Angela Hood
LICENSING EVALUATOR SIGNATURE: DATE: 08/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/03/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1