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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604123
Report Date: 04/29/2024
Date Signed: 04/29/2024 10:51:36 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/12/2024 and conducted by Evaluator Crystal Colvin
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20240312155326
FACILITY NAME:MERAKEY - WYNDEMEREFACILITY NUMBER:
374604123
ADMINISTRATOR:BUCKINGHAM, ADELITAFACILITY TYPE:
737
ADDRESS:26184 WYNDEMERE CTTELEPHONE:
(442) 286-7548
CITY:ESCONDIDOSTATE: CAZIP CODE:
92026
CAPACITY:4CENSUS: 4DATE:
04/29/2024
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Adelita Buckingham - AdministratorTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Client was not accorded dignity in relationships with staff
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Crystal Colvin and Valarie Flores arrived at the facility unannounced in order to deliver findings for an investigation of a complaint with the above allegation(s). LPA identified herself and discussed the purpose of the visit and the elements of the allegation(s) with Administrator Adelita Buckingham. Below is a summary of the complaint investigation findings:

Regarding allegation “Client was not accorded dignity in relationships with staff”: LPA Colvin conducted interviews with resident and staff, as well as reviewed security camera footage from the facility. Based on interviews conducted, LPA Colvin confirmed that on 3/8/24 there was an incident in the dining room of the facility where Staff One (S1) was confronting Resident One (R1) about R1 having stolen soda out of the facility’s “store”. During this confrontation, R1 approached S1, and after briefly retreating to R1’s prior position in the room, R1 then lunged at S1 and hit them in the face. According to the complaint, S1 potentially retaliated with an improper hold on R1.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2024
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 18-AS-20240312155326
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: MERAKEY - WYNDEMERE
FACILITY NUMBER: 374604123
VISIT DATE: 04/29/2024
NARRATIVE
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In LPA Colvin’s interview with S1, S1 stated that they pushed R1 away from them with their arm due to R1 having bitten their arm and needing to “feed the bite” as proper procedure to reduce further injury and encourage R1 to release.

When LPA Colvin reviewed the security footage from the incident, LPA Colvin observed the following: At 8:47:15, R1 lunges towards S1 and hits S1 in the face. At 8:47:16, S1 gets their left arm around in-between R1 and themselves and starts pushing R1 backwards towards the wall/window. At this point it is clear that R1’s mouth is not on S1’s arm, and R1’s head is in fact turned away from S1 and facing the camera. S1 continues to push R1 the length of the table towards the window/wall, and it is not until 8:47:18 that R1 puts their mouth on S1’s arm, which is now pushing against R1’s face while S1 forces R1 backwards. At 8:47:19, R1 becomes pinned against the window and has their mouth on S1’s arm while S1 is still pushing into them. The video footage shows additional facility staff coming to assist and actually pulling S1 off of R1 and removing S1’s arm from R1’s mouth.

Based on LPA Colvin’s review of the video footage, the series of events are different than what was stated by S1, as S1 had opportunity to disengage from the conflict with R1, and if S1 had done so, it is likely that R1 would not have had the opportunity to bite S1’s arm, which further escalated the incident. At the time of S1 pushing R1 backwards across the length of the dining room table and almost up until R1 was pinned against the window, S1’s arm was not yet in R1’s mouth, therefore discrediting S1’s reason for why they needed to push into R1. Therefore, based on video footage obtained from the facility, the allegation “Client was not accorded dignity in relationships with staff” is SUBSTANTIATED.

A finding that the complaint is SUBSTANTIATED means that the allegation(s) is valid because the preponderance of the evidence standard has been met.

Due to observations made by LPA Colvin, the facility was cited, and deficiencies noted on LIC 9099 D. An exit interview was conducted where this report and appeal rights were discussed. A copy this report, LIC 9099D, and appeal rights were provided to Administrator Adelita Buckingham during the exit interview.

SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20240312155326
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: MERAKEY - WYNDEMERE
FACILITY NUMBER: 374604123
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/30/2024
Section Cited
CCR
80072(a)(1)
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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 was not met by:
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The facility has already re-trained staff on CPI, had staff review R1's behavior plan, and spoken with R1 about the situation and how to better support R1 in the future. Additionally, S1 has been terminated due to the incident. Administrator additionally states
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Based on video footage review, the Licensee did not comply with the above regulation with one resident (R1) and one staff (S1). On 3/8/24, S1 forcibly pushed R1 away from themselves and up against a window after R1 had hit S1. This was an immediate personal rights violation of R1.
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that they will develop a training for staff, specific to R1, which details behaviors for staff to watch out for as well as how to respond and how not to respond. Administrator to provide LPA Colvin with a draft of the proposed training by Plan of Correction date of 4/30/24.
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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: Tricia Danielson
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3