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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604368
Report Date: 02/09/2023
Date Signed: 02/09/2023 01:48:42 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, 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
10/10/2022 and conducted by Evaluator Chinwe Nwogene
COMPLAINT CONTROL NUMBER: 18-AS-20221010121134
FACILITY NAME:MERAKEY - AMPAROFACILITY NUMBER:
374604368
ADMINISTRATOR:LYLES, BRITTANNYFACILITY TYPE:
737
ADDRESS:479 AMPARO DRIVETELEPHONE:
(442) 277-4554
CITY:ESCONDIDOSTATE: CAZIP CODE:
92025
CAPACITY:4CENSUS: 4DATE:
02/09/2023
UNANNOUNCEDTIME BEGAN:
10:06 AM
MET WITH:Carly Adams, interim Administrator and Nadia Moreno, CaregiverTIME COMPLETED:
01:55 PM
ALLEGATION(S):
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Facility did not allow resident to attend an activity.
Resident is not administered medication as prescribed.
INVESTIGATION FINDINGS:
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On February 9, 2023, Licensing Program Analyst (LPA), Chinwe Nwogene conducted an unannounced visit to conclude the complaint investigation into the allegation listed above. LPA met with interim Administrator, Carly Adams and Caregiver, Nadia Moreno and explained the purpose of the visit. During the investigation staff, and Endocrinology Nurse was interviewed, and resident’s file was reviewed.
Regarding the allegation “Facility did not allow resident to attend an activity”, it was alleged staff didn’t not allow resident to attend the Halloween activity at Sea world. LPA interviewed staff who stated resident was in the Emergency Room for three days and returned to the facility in the early morning of the day of the Halloween activity at Sea world. Staff stated based on resident’s recovery from Emergency Room, resident was not in condition to go on a strenuous all-day activity.
Regarding the allegation “Resident is not administered medication as prescribed”, It was alleged staff didn’t administer resident’s insulin “Lantus” at the time prescribed. LPA interviewed staff who stated Lantus is a twenty-four hours acting insulin prescribed to be given once a day at 6.00pm. Staff stated facility has one-hour window to administer the Lantus and the Lantus was administered daily within an hour of the prescribed time. LPA interviewed Endocrinology Nurse on behalf of Resident’s Endocrinology doctor. Nurse stated Lantus is not a time sensitive insulin and can be given in an hour of the prescribe time. Endocrinology Nurse stated facility has one-hour window to administer the Lantus. Resident Medication Administration Record (MAR) was reviewed. Resident’s MAR revealed Lantus was administered within an hour of the prescribed time and on the days, resident was at the facility.

Continue on LIC9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Chinwe Nwogene
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023
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 2
Control Number 18-AS-20221010121134
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: MERAKEY - AMPARO
FACILITY NUMBER: 374604368
VISIT DATE: 02/09/2023
NARRATIVE
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Continued from LIC9099.

Based on LPA’s interviews and resident’s file review, there is not enough evidence to support the above allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated at this time. An exit interview was conducted, and a copy of this report was reviewed with and provided to Nadia Moreno.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Chinwe Nwogene
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2