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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700650
Report Date: 06/06/2022
Date Signed: 06/06/2022 02:37:46 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/25/2022 and conducted by Evaluator Kevin Mknelly
COMPLAINT CONTROL NUMBER: 25-AS-20220325140023
FACILITY NAME:MERAKEY - PARKSFACILITY NUMBER:
342700650
ADMINISTRATOR:CHANESE THOMASFACILITY TYPE:
737
ADDRESS:3333 PARKS LANETELEPHONE:
(916) 609-2426
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:4CENSUS: 4DATE:
06/06/2022
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Sumaira KausarTIME COMPLETED:
02:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Caregiver physically abused a resident during a physical restraint.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 6/6/22, Licensing Program Analyst (LPA) Kevin Mknelly conducted an unannounced complaint investigation visit to deliver the findings for the above allegations and met with clinical staff. Prior to initiating the complaint visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. Upon arrival, completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA was screened with temperature at the facility.

LPA conducted records review and extensive interviews.
LPA is unable to find and or meet the preponderance, per policy.

Report continued
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2022
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 25-AS-20220325140023
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: MERAKEY - PARKS
FACILITY NUMBER: 342700650
VISIT DATE: 06/06/2022
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
26
27
28
29
30
31
32
On 3/9/22, at approximately 12:30 AM, R1 was reported, in an incident report, to have awoken and been incontinent. The report further stated that as S1 and S2 attempted to have R1 change their clothes, R1 declined to change and was focused on something else that they wanted. When R1’s request was denied until they were changed from their wet clothes, R1’s behavior escalated to property damage and self-injury.
Staff initiated emergency intervention techniques that resulted in R1 having a prone, 2-person restraint for approximately 5 minutes. Following the intervention, R1 was seen my emergency responders for self-injuries.

R1’s Functional Behavior Assessment / Individual Behavioral Support Plan last updated 5/2021 states that “Merakey utilizes only ProACT containment as a last resort. Merakey only approves a standing containment or a wall containment as a last resort”. S1 and S2 stated that R1 lowered himself to a prone position on 3/9/22 and that they then held him there in order to limit further self-injury.

It is then alleged that S1 made statements on 3/23/22 to other staff members that on 3/9/22 in an intervention with R1, that S1 made statements of getting “kicks in”, putting their full weight on R1 and taunting R1 with “this is what you wanted”.

LPA Mknelly interviewed staff who were present on 3/9/22 at the time of R1’s incident and staff who were present on 3/23/22 for the alleged statements.

No other staff person made statements when interviewed of witnessing S1 abuse R1 on 3/9/22. Furthermore, no other staff person made statements when interviewed of witnessing S1 making the alleged statements on 3/23/22.

S1 and S2 acknowledged that the prone containment used on 3/9/22 was not approved in Merakey policy nor R1’s intervention plan for the prone containment.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 25-AS-20220325140023
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: MERAKEY - PARKS
FACILITY NUMBER: 342700650
VISIT DATE: 06/06/2022
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
26
27
28
29
30
31
32
In interview with LPA, S1 stated that when R1 was escalating on 3/9/22, he made the statement to R1 “you don’t want to do this”- meaning the physical restraint that would result if R1’s behavior continued. This is not an approved strategy to R1’s behavior plan and could be interpreted by R1 as a threat. R1 was unable to participate in an interview regarding 3/9/22.

By reports, R1 continued to have a good relationship with S1 following the intervention of 3/9/22. S1 has resigned from work at the facility.

As a result of this investigation, LPA finds allegation to be (US)Unsubstantiated - A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview with administrator.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3