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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392701088
Report Date: 03/20/2024
Date Signed: 03/20/2024 12:01:28 PM

Substantiated


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
12/21/2023 and conducted by Evaluator Jason Lund
COMPLAINT CONTROL NUMBER: 27-AS-20231221141730
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:
03/20/2024
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Adminstrator Ryiesha LevingstonTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Staff yelled at resident.
INVESTIGATION FINDINGS:
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On 3/20/2024 Licensing Program Analyst (LPA) Jason Lund arrived to the facility unannounced to deliver findings to a complaint investigation. LPA Lund met with Adminstrator Ryiesha Levingston and explained the purpose of the visit. Census: 4

This investigation was conducted by LPA Maja Jensen. During the course of the investigation LPA Jensen interviewed 11 staff members. The staff members interviewed included 2 former staff members and 9 current staff members in different positions with varying degrees of responsibility and duties. LPA Jensen attempted to interview an additional 6 former or current staff members but did not get a response. LPA Jensen also reviewed records that include training records, staff roster, and staff schedule.
Substantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024
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 5
Control Number 27-AS-20231221141730
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: 03/20/2024
NARRATIVE
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The interviews conducted revealed that 3 of 11 current or former staff members, including the Administrator, stated they had witnessed or had knowledge of a staff member yelling at residents. A former staff member indicated that while she did not have any knowledge of staff yelling at residents, she did believe that some staff had grown accustomed to speaking to residents in a familial manner as opposed to a professional manner and this was discouraged as it could be misconstrued as offensive. A current staff member stated that some staff have loud voices, so they are not able to discern if they were yelling or not. The facility Administrator and an Executive Director confirmed that the staff members that they believe to have yelled at residents have been terminated. It should be noted that multiple staff members indicated that the facility conducts comprehensive training on personal rights and abuse with the most recent training having been conducted in March of 2024.

Based on the interviews conducted the allegation of “staff yelled at residents” is SUBSTANTIATED. A finding of substantiated means that the preponderance of evidence standard has been met.

A deficiency is being cited pursuant to the California Code of Regulations (CCR) Title 22, Division 6. Failure to correct deficiencies may result in the assessment of civil penalties.

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

DATE: 03/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 27-AS-20231221141730
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/03/2024
Section Cited
CCR
80072(a)(1)
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Each client shall have personal rights which include, but are not limited to, the following:
To be accorded dignity in his/her personal relationships with staff and other persons
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The facility has terminated staff members that have been identified as yelling at residents. Will conduct a training on how to treat clients in care.
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This requirement was not met as evidenced by: Staff have had witnessed or had knowledge of a staff member yelling at residents. poses a potential risk to the health, welfare, or personal rights risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
12/21/2023 and conducted by Evaluator Jason Lund
COMPLAINT CONTROL NUMBER: 27-AS-20231221141730

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:
03/20/2024
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Adminstrator Ryiesha LevingstonTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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2
3
4
5
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9
Staff grabbed resident by the neck
INVESTIGATION FINDINGS:
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On 3/20/2024 Licensing Program Analyst (LPA) Jason Lund arrived to the facility unannounced to deliver findings to a complaint investigation. LPA Lund met with Adminstrator Ryiesha Levingston and explained the purpose of the visit. Census: 4

This investigation was conducted by LPA Maja Jensen. During the course of the investigation LPA Jensen interviewed 11 staff members. The staff members interviewed included 2 former staff members and 9 current staff members in different positions with varying degrees of responsibility and duties. LPA Jensen attempted to interview an additional 6 former or current staff members but did not get a response. LPA Jensen also reviewed records that include training records, staff roster, and staff schedule.
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 27-AS-20231221141730
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: 03/20/2024
NARRATIVE
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There was only one former staff member that alleged a resident was grabbed by the neck by a Direct Service Provider. The Administrator confirmed that an internal incident investigation was conducted by the facility’s Quality and Compliance Organization. This internal investigation concluded that the allegation was false. Based on interviews conducted the allegation of “staff grabbed resident by the neck” is UNSUBSTANTIATED. A finding of unsubstantiated means that although the allegation may have happened, the preponderance of evidence does not prove it.

An exit interview was conducted and a copy of this report, appeal rights and a confidential names list was provided.

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

DATE: 03/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5