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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455002818
Report Date: 09/10/2024
Date Signed: 09/10/2024 09:09:38 AM

Document Has Been Signed on 09/10/2024 09:09 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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:MERAKEY - OLD 44FACILITY NUMBER:
455002818
ADMINISTRATOR/
DIRECTOR:		SHAW, NATALIEFACILITY TYPE:
738
ADDRESS:21345 OLD 44 ROADTELEPHONE:
(530) 768-7336
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY: 4CENSUS: 4DATE:
09/10/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:15 AM
MET WITH:Administrator Assistant, Samantha Alexander
Program Administrator, Natalie Shaw		TIME VISIT/
INSPECTION COMPLETED:
08:45 AM
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On September 10, 2024 at approximately 08:15 AM, Licensing Program Analyst (LPA), Farhaan Sarangi arrived at Merakey-Old 44 unannounced for the purpose of conducting a Case Management-Incident inspection. Upon arrival, LPA was greeted at the door by, Administrator Assistant, Samantha Alexander, and was granted access into the facility. Administrator arrived 20 minutes later.

On August 30, 2024, the facility reported to Community Care Licensing Division (CCLD) regarding one client receiving medication at the wrong time. The Incident Report summarizes that at 08:00 AM medications was being passed when the staff noticed that the medication was supposed to be for 04:00 PM and not 08:00 AM (See LIC 9102-Technical Violation). Administrator and the Registered Nurse (RN) were immediately notified. Staff that dispensed the wrong medication were retrained. LPA educated the Administrator Assistant regarding the importance of dispensing the medications appropriately and as outlined in Title 22 regulation.

No deficiencies were cited during today's Case Management-Incident Inspection. Exit interview was conducted and a copy of this report was signed and given to the Administrator.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE: DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2024
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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