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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 455002818
Report Date: 09/13/2023
Date Signed: 09/13/2023 10:01:59 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH 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
08/07/2023 and conducted by Evaluator Donna Gurriere
PUBLIC
COMPLAINT CONTROL NUMBER: 59-AS-20230807105919
FACILITY NAME:MERAKEY - OLD 44FACILITY NUMBER:
455002818
ADMINISTRATOR:PLUNKETT, WILLIAMFACILITY TYPE:
738
ADDRESS:21345 OLD 44 ROADTELEPHONE:
(530) 768-7336
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY:4CENSUS: 3DATE:
09/13/2023
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:NATALIA SHAWTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Staff violated resident’s personal rights.
INVESTIGATION FINDINGS:
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On 09/13/23, Donna Gurriere, Licensing Program Analyst (LPA) arrived at the facility unannounced to deliver final findings regarding a complaint that was received on 08/07/23. LPA Gurriere met with Natalia Shaw, Lead Staff Person and explained the purpose of the visit.

Staff violated resident’s personal rights.

During the interview process, the administrator, eight staff persons, the regional center supervisor and two residents were interviewed. Various documents were obtained and reviewed to include Individual Behavior Support Plan (IBSP), Individual Development Plan (IDP), Medication Administration Record (MARs), incident reports, resident observation log, resident names, staff names and telephone numbers.

continued
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Donna Gurriere
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023
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 59-AS-20230807105919
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: MERAKEY - OLD 44
FACILITY NUMBER: 455002818
VISIT DATE: 09/13/2023
NARRATIVE
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continued



During the investigation, it was reported that a resident (Resident 1) did not want to get up in the morning to take her medications and a staff person said, “You are an adult, and you need to take your medications like a ‘expletive word’ grown-ass adult.” Several staff persons stated that they heard of the allegation but did not witness it. The staff person that was accused of the statement, and a witness stated that the statement or language was not used. The resident stated that she does not remember an incident where the staff person made the statement or used foul language. It is unknown if the resident remembers the incident or not, as it is noted in the resident’s IBSP that she has a poor memory.

Based on the resident’s statements it is noted that although the above allegation mentioned may have happened, or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the findings are Unsubstantiated.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Donna Gurriere
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2