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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392701088
Report Date: 07/24/2024
Date Signed: 07/24/2024 03:00:11 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH 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
04/25/2024 and conducted by Evaluator Jason Lund
COMPLAINT CONTROL NUMBER: 27-AS-20240425160139
FACILITY NAME:MERAKEY - DELAWAREFACILITY NUMBER:
392701088
ADMINISTRATOR:RYIESHA LEVINGSTONFACILITY TYPE:
737
ADDRESS:3511 DELAWARE AVETELEPHONE:
(760) 571-0953
CITY:STOCKTONSTATE: CAZIP CODE:
95204
CAPACITY:4CENSUS: 4DATE:
07/24/2024
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Administrator Ryiesha LevingstonTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff do not provide the clients privacy
Staff are interrupting the clients while sleeping
Staff do not properly feed the clients
Staff do not provide adequate hygiene products
Staff do not seek timely medical attention for the clients
Staff do not timely address the clients change in medical condition
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jason Lund arrived unannounced to complete a complaint investigation. LPA Lund met with Administrator Ryiesha Levingston and explained the reason for the visit. Census:4

Staff do not provide the clients privacy- Based on records reviewed, interviews with reporting party, staff and witness. LPA Lund reviewed facility records. Staff sign a Professional Boundaries Policy regarding in their interactions with individuals that the facility serve. LPA Lund reviewed four clients in care Individual Behavior Support Plans (IBSP) which states that two clients have at one staff-to-one care (Ratio). The other two clients in care have two staff- to one care (Ratio). Two clients Functional Behavior Assessment (FBA) & Individualized Behavior Support Plans (IBSP) staff are providing line of sight supervision at all times. Staff interviewed stated that they close the restroom door while clients are in the restroom and give them the privacy as needed. Management stated that clients are given as much privacy based on each client’s IBSP plan needed to support the client’s needs at the facility.
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024
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 4
Control Number 27-AS-20240425160139
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: MERAKEY - DELAWARE
FACILITY NUMBER: 392701088
VISIT DATE: 07/24/2024
NARRATIVE
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Based on records reviewed, interviews with reporting party, staff and witness the information provided, it was unclear if staff do not provide the clients privacy therefore the allegation was deemed UNSUBSTANTIATED.

Staff are interrupting the clients while sleeping- Based on records reviewed, interviews with clients, reporting party, staff, and witness. LPA Lund reviewed facility records. Two of the clients Individual Behavior Support Plan (IBSP) states that the facility staff will check on these two clients every 30 minutes during evening hours while sleeping. Management has stated that the other two clients are checked on every 30 minutes during evening hours while sleeping. Staff interviewed stated that they check clients in care at night every half hour but do not wake them up in less necessary. The female clients are checked for two procedures (Needs) while sleeping.

Based on records reviewed, interviews with clients, reporting party, staff and witness the information provided, it was unclear if staff are interrupting the clients while sleeping therefore the allegation was deemed UNSUBSTANTIATED.

Staff do not properly feed the clients- Based on records reviewed, LPA Lund’s & witness observation and, interviews with reporting party, witness, and staff. LPA Lund reviewed facility food orders from Walmart dated March 27, 2024, through April 26, 2024. LPA Lund observed sufficient 7-day nonperishable and 2-day perishable foods at the facility. The facility has schedule snacks times at 10 AM, 3 PM & 8 PM or when clients ask for snacks. The facility has two clients that have pica and staff monitor those two clients to make sure they are eating safe and not eating anything they should not be eating.

Based on records reviewed, LPA Lund’s & witness observation, interviews with reporting party, witness, and staff the information provided, it was unclear if staff do not properly feed the clients therefore the allegation was deemed UNSUBSTANTIATED.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 27-AS-20240425160139
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: MERAKEY - DELAWARE
FACILITY NUMBER: 392701088
VISIT DATE: 07/24/2024
NARRATIVE
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Staff do not provide adequate hygiene products- Based on facility records reviewed, LPA Lund’s & witness observations, interviews with reporting party, witness, and staff. LPA Lund reviewed facility records February 29, 2024, through May 31, 2024, for hygiene products for clients in care. Staff interviewed stated that the female clients in care have sufficient hygiene products and if clients need more hygiene products the facility will immediately order more products. Witness observation observed that each client in care is properly maintained during the witness visits at the facility.

Based on facility records reviewed, LPA Lund’s & witness observations, interviews with reporting party, witness, and staff the information provided, it was unclear if staff do not provide adequate hygiene products therefore the allegation was deemed UNSUBSTANTIATED.

Staff do not seek timely medical attention for the clients- Based on records reviewed, interviews with reporting party, witness, and staff. LPA Lund reviewed facility records which states that Client (C1) has had symptoms since C1’s arrival at the facility on 7/19/2023. C1 has an PRN (When necessary) for symptoms to take when needed. Staff interviewed stated they will give C1 the PRN when necessary. C1 has referrals to Specialist for the condition and will go to emergency room if necessary.

Based on records review, interviews with reporting party, witness and staff the information provided, it was unclear if staff do not seek timely medical attention for the clients therefore the allegation was deemed UNSUBSTANTIATED.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 27-AS-20240425160139
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: MERAKEY - DELAWARE
FACILITY NUMBER: 392701088
VISIT DATE: 07/24/2024
NARRATIVE
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Staff do not timely address the clients change in medical condition- Based on records reviewed, interviews with reporting party, witness, and staff. LPA Lund reviewed facility records that showed that Client (C2) was sent to Urgent Care on 4/25/2024 and was prescribed medications for C2’s condition. C1 is still taking the medications as an PRN (When necessary). Staff interviewed stated that when C2’s condition was noticed C2 was taken to Urgent Care for treatment when observed. Witness stated was aware of C2's condition and the facility notified Valley Mountain Regional Center Service Coordinator.

Based on records reviewed, interviews with reporting party, witness, and staff the information provided, it was unclear if staff do not timely address the clients change in medical condition therefore the allegation was deemed UNSUBSTANTIATED.

The Department (CCLD) has found the allegations. Unsubstantiated.

A finding that the complaint allegation(s) are UNSUBSTANTIATED means that although the allegation(s) may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation(s) occurred. Exit interview was conducted with and report left.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4