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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700650
Report Date: 02/14/2025
Date Signed: 02/14/2025 04:47:31 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH 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
10/25/2024 and conducted by Evaluator Angela Hood
COMPLAINT CONTROL NUMBER: 59-AS-20241025093423
FACILITY NAME:MERAKEY - PARKSFACILITY NUMBER:
342700650
ADMINISTRATOR:KYRIE S RICHARDSONFACILITY TYPE:
737
ADDRESS:3333 PARKS LANETELEPHONE:
(916) 609-2425
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:4CENSUS: 4DATE:
02/14/2025
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Kimberly Simpkins, Regional Director and Jordan Tracy, Administrator AssistantTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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-Staff did not treat client with dignity or respect
-Staff did not implement training appropriately
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angela Hood arrived at the care home today, February 14, 2025, and met with the Administrator Assistant, Jordan Tracy, to deliver complaint investigation findings regarding the above stated allegations.

During the course of the investigation, LPA reviewed the videos received with the complaint, conducted interviews, and obtained documentation pertinent to the investigation.

According to resident (R1's) admission agreement, R1 was admitted to the facility on June 13, 2024. On October 25,2024, a complaint was received by the department including two videos of R1, one with audio and one without. The dates of the videos are unknown, however, were taken between R1's admission date and the date the complaint was filed. The video with audio showed R1 hitting themselves in the head. Staff (S2) picked up the Ukeru pad to block R1 from continuing behavior. Staff (S1) appeared in the video and **********************************************Continued on LIC9099-C*************************************************
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Angela Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2025
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 5
Control Number 59-AS-20241025093423
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: MERAKEY - PARKS
FACILITY NUMBER: 342700650
VISIT DATE: 02/14/2025
NARRATIVE
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held onto R1's arm and back directing them away from S2. R1 then turned towards S1 and it's unclear if S1 was pulling R1 or R1 was grabbing S1 as R1's back was turned towards the individual that was recording the video. It is unknown who recorded the video. Interviews with staff (S3, S4, S5, S6, and S7) indicated that they did not witness the incident. The visual and audio of the video showed S1 and S2 laughing during the incident as well as the video recorder laughing.

Interviews with Administrator and Regional Director indicated that the appropriate training was not utilized by S1. Regional Director has conducted the Ukeru pad training for staff and indicated that S2 implemented the correct training of the Ukeru pad. However, S1 did not implement the appropriate training for the situation. Regional Director indicated that staff are not trained to grab a residents' arm the way S1 did in the situation. Interviews with Regional Director and Administrator Assistant indicated that staff are trained to put their hand in a "C" shape to prevent grabbing a resident, which could cause injuries to both resident and staff.

S1 and S2 received training regarding their behavioral intervention plan for R1. S1 received the training on August 22, 2024 and S2 on October 9, 2024. S1 and S2 had also completed their annual Ukeru pad training.

Upon opening of the complaint investigation, S1 and S2 were both temporarily suspended, while the facility conducted an internal investigation. The internal investigation findings have been completed, however, the report is not yet finished. S1 and S2 have since been terminated.

Based on observation of videos, interviews conducted, and records reviewed, the preponderance of evidence standards have been met. Therefore, the above allegations are found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies are being cited on the attached 9099-D page.

Exit interview conducted. A copy of the report and appeal rights provided.

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Angela Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 59-AS-20241025093423
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: MERAKEY - PARKS
FACILITY NUMBER: 342700650
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/14/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/28/2025
Section Cited
CCR
80065(a)
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80065 Personnel Requirements (a) Facility personnel shall be competent to provide the services necessary to meet individual client needs...
This requirement is not met as evidenced by:
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Administrator agrees to submit a plan to ensure there is oversight of staff and that they are implementing their training appropriately. Plan to be submitted to LPA by the POC due date of 2/28/25.
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Based on observation of videos received, interviews conducted, and records reviewed, although staff completed the training, they were not competent to successfully utilize the training to meet the individual clients' needs during a behavior, which poses a potential health, safety, and personal rights risk to residents in care.
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Type B
02/28/2025
Section Cited
HSC
80072(a)(1)
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80072 Personal Rights (a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following: (1) To be accorded dignity in his/her personal relationships with staff and other persons.
This requirement is not met as evidenced by:
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Administrator agrees to conduct a staff training, ensuring all staff understand the importance of according dignity and respect to residents. Proof of training indicating the date and all participants to be submitted to LPA by the POC due date of 2/28/25.
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Based on observation of videos, staff were laughing during resident (R1) exhibiting a self injurious behavior, which poses a potential health, safety, and personal rights risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Angela Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH 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
10/25/2024 and conducted by Evaluator Angela Hood
COMPLAINT CONTROL NUMBER: 59-AS-20241025093423

FACILITY NAME:MERAKEY - PARKSFACILITY NUMBER:
342700650
ADMINISTRATOR:KYRIE S RICHARDSONFACILITY TYPE:
737
ADDRESS:3333 PARKS LANETELEPHONE:
(916) 609-2425
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:4CENSUS: 4DATE:
02/14/2025
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Kimberly Simpkins, Regional Director and Jordan Tracy, Administrator AssistantTIME COMPLETED:
05:00 PM
ALLEGATION(S):
1
2
3
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5
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7
8
9
-Staff handled client in a rough manner
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angela Hood arrived at the care home today, February 14, 2025, and met with the Administrator Assistant, Jordan Tracy, to deliver complaint investigation findings regarding the above stated allegations.

During the course of the investigation, LPA reviewed the videos received with the complaint, conducted interviews, and obtained documentation pertinent to the investigation.
On October 25, 2024, a complaint was received by the department including two videos of R1, one with audio and one without. The dates of the videos are unknown, however, were taken between R1's admission date of June 13, 2024 and the date the complaint was filed. In the video with audio, R1 is hitting themselves in the head. Staff (S2) appeared to be utilizing the Ukeru pad to block R1 from continuing behavior. Staff (S1) appeared in the video and held onto R1's arm and back directing away from S2. R1 then turned towards S1 and it's unclear if S1 was pulling R1 or R1 was grabbing S1 as R1's back was turned towards
*********************************************Continued on LIC9099-C**************************************************
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Angela Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 59-AS-20241025093423
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: MERAKEY - PARKS
FACILITY NUMBER: 342700650
VISIT DATE: 02/14/2025
NARRATIVE
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the individual who was recording the video. It is unknown who recorded the video. Interviews with staff (S3, S4, S5, S6, and S7) indicated that they did not witness the incident and have not witnessed staff being rough with residents in care.

Based on observation and interviews conducted, 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. Therefore, the allegation is UNSUBSTANTIATED. No deficiency is being cited.

Exit interview conducted. A copy of the report was provided.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Angela Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5