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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604368
Report Date: 07/17/2023
Date Signed: 07/17/2023 02:21:40 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
07/12/2023 and conducted by Evaluator Chinwe Nwogene
COMPLAINT CONTROL NUMBER: 18-AS-20230712165023
FACILITY NAME:MERAKEY - AMPAROFACILITY NUMBER:
374604368
ADMINISTRATOR:CARLY ROQUEMOREFACILITY TYPE:
737
ADDRESS:479 AMPARO DRIVETELEPHONE:
(442) 277-4554
CITY:ESCONDIDOSTATE: CAZIP CODE:
92025
CAPACITY:4CENSUS: 4DATE:
07/17/2023
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Carly Adams, Administrator TIME COMPLETED:
02:25 PM
ALLEGATION(S):
1
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9
Facility staff is not following resident's care plan.
INVESTIGATION FINDINGS:
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2
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5
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13
On 7/17/2023, Licensing Program Analyst (LPA) Chinwe Nwogene conducted an unannounced visit to investigate the above allegation. 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 reviewed facility record.
Regarding the allegation “Facility staff is not following resident's care plan”, it was alleged staff is not by resident’s side within arm’s reach when assigned to provide one on one to resident. LPA interviewed staff who denied not following resident’s care plan. Staff stated resident is assigned a staff daily to provide one on one services. Staff stated resident has aggressive behavior and will hit staff. 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.
Based on LPA’s observation, interview with staff, and facility record review, there is not enough evidence to support the above allegation. 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 at this time. An exit interview was conducted, and a copy of this report was reviewed with and provided to Jazmin Espinoza.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Chinwe Nwogene
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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