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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392701088
Report Date: 02/01/2024
Date Signed: 02/01/2024 10:40:05 AM

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
10/17/2023 and conducted by Evaluator Maja Jensen
COMPLAINT CONTROL NUMBER: 27-AS-20231017123643
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:
02/01/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Ryiesha LevingstonTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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9
Staff inappropriately interacted with a resident
INVESTIGATION FINDINGS:
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On 2/1/24 Licensing Program Analysts (LPAs) Maja Jensen and Jason Lund arrived at facility unannounced to continue a complaint investigation in to the above listed allegation. LPAs Jensen and Lund met with Ryiesha Levingston and explained the purpose of today’s visit.

During the course of the investigation, LPA Jensen reviewed records including a comprehensive Quality and Compliance Organization Incident Investigation Report. This report details findings resulting from the facilities internal investigation which consisted of interviews with 9 staff members. 8 of 9 staff members deny having witnessed or having any knowledge of inappropriate behavior between staff and Resident 1 (R1). In addition, LPA Jensen also reviewed records that include R1’s personal profile, Individual Program Plan.


Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2024
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 2
Control Number 27-AS-20231017123643
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: 02/01/2024
NARRATIVE
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LPA Jensen also personally interviewed 1 current staff member (S1) and 2 former staff members (S2 and S3). S2 states that they witnessed what appeared to be an inappropriate physical interaction wherein a staff member (S4) rubbed their head against the nape of the neck of R1. S2 also stated that they had overheard other employees say that S4 had left the facility for an unusually long period of time with R1 but did not have first hand knowledge of the event. S1 and S3 denied any inappropriate action by facility staff taking place during the occurrences in question.

Based on the interviews conducted and records reviewed, the allegation of Staff inappropriately interacted with a resident is UNSUBSTANTIATED. A finding of unsubstantiated means that although the allegation may have happened, the preponderance of evidence does not prove it.

No deficiencies are being cited as a result of this investigation. An exit interview was conducted and a copy of this report, appeal rights and an LIC 811 was handed to Ryiesha Levingston.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2