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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392701088
Report Date: 02/20/2024
Date Signed: 02/22/2024 08:59:12 AM

Document Has Been Signed on 02/22/2024 08:59 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
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: DATE:
02/20/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Merakey Executive Staff and Regional Center TIME COMPLETED:
05:15 PM
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On 2/20/24 There was an informal meeting held via Microsoft Teams to discuss visitor safety at the facility. In attendance were Stephenie Doub, Sacramento South Regional Manager, Lisa Rios, Licensing Program Manager, Maja Jensen, Licensing Program Analyst, Brian Bennet Valley Mountain Regional Center Director, Katina Richison, Valley Mountain Regional Center Division Manager, Wanda Johnson, Valley Mountain Regional Center Senior Community Liason, Beth Caraccio, Merakey Vice President, Alisa Dean, Merakey Senior Executive Director, Paola Ortiz, Merakey Executive Director and Marilou Malvar, Merakey Regional Nurse.

The Department requested an update on what measures are being taken to protect visitor safety in light of at least 4 known incidents that have occurred over the course of less than 3 month time period wherein a resident has physically assaulted either Merakey staff or Department staff and law enforcement had to be called to physically restrain Resident 1 (R1). Merakey management advised they have conducted additional staff training consisting of empowering staff to direct visitors as needed ad away from harm. Merakey Management also advised they are adjusting medications, in conjuction with medical provicders for R1, on a trial and error basis. The Licensee agrees to send supporting documentation for the training conducted. The Regional Center Management agreed to have their planning committee coordinate with Department staff in order to apprise them of the opportunities to conduct site visits that pose he least amount of risk. Merakey management agreed to work with R1 to assist in facilitating having R1 be away from the facility as scheduled by the planning committee to the greatest extent possible so that site visits can be safely conducted.

This report is being sent to Alisa Dean for electronic signature.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE: DATE: 02/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/22/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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