374604368-7-6-2023-18-AS-MVAO-D2DVBG-20240212151731

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604368
Report Date: 07/06/2023
Date Signed: 07/06/2023 01:13:44 PM

Unsubstantiated

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
06/28/2023 and conducted by Evaluator Chinwe Nwogene

COMPLAINT CONTROL NUMBER: 18-AS-20230628104035

FACILITY NAME:	MERAKEY - AMPARO		FACILITY NUMBER:	374604368
ADMINISTRATOR:	CARLY ROQUEMORE		FACILITY TYPE:	737
ADDRESS:	479 AMPARO DRIVE		TELEPHONE:	(442) 277-4554
CITY:	ESCONDIDO	STATE: CA	ZIP CODE:	92025
CAPACITY:	4	CENSUS: 4	DATE:	07/06/2023
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Carly Adams, Administrator		TIME COMPLETED:	01:20 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

PERSONAL RIGHTS.
FACILITY NOT FOLLOWING TREATMENT PLAN FOR RESIDENT.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 7/6/2023, Licensing Program Analyst (LPA) Chinwe Nwogene conducted an unannounced visit to investigate the above allegations. LPA met with Administrator, Carly Adams and Administrator trainee, Jazmin Espinoza who was informed of the purpose of the visit. At the time of visit, LPA interviewed staff and residents, reviewed resident file and facility record.
Regarding the allegation “Personal Right”, it was alleged staff violated resident’s personal right. LPA interviewed staff who denied violating resident’s personal right. Staff stated resident has rights just like everyone else. Staff stated resident have the right to make their own choices and to refuse services. LPA attempted to interview resident who declined to be interviewed. LPA reviewed facility daily notes, daily notes revealed no evidence of personal right violation.
Regarding the allegation “Facility not following treatment plan for resident”, it was alleged staff is not by resident’s side when assigned to provide one on one to resident. LPA interviewed staff who denied not following resident’s treatment plan. Staff stated resident is assigned a staff daily to provide one on one services. LPA reviewed staff schedule and observed resident is assigned a one-on-one staff daily. During LPA’s visit LPA observed resident had a one-on-one staff by resident's side. LPA observed the one-on-one staff never left resident’s side.

Continue on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Chinwe Nwogene
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023

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-20230628104035

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 - AMPARO	FACILITY NUMBER: 374604368
	VISIT DATE: 07/06/2023

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

Continued from LIC9099.

Based on LPA’s observation, interview with staff and resident, resident file review and facility record 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 Carly Adams.

SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Chinwe Nwogene
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2