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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455002818
Report Date: 10/01/2024
Date Signed: 10/01/2024 01:49:30 PM

Document Has Been Signed on 10/01/2024 01:49 PM - 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:
10/01/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Program Administrator, Ezekial ContrerasTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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On October 1, 2024 at approximately 1:15 PM, Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at Merakey-Old 44 for the purpose of conducting a Case Management-Incident Inspection. LPA was greeted at the door by Program Administrator, Ezekial Contreras and was granted access into the facility.

An SOC 341 and an incident report was forwarded to the Community Care Licensing Division on September 25, 2024 regarding a client and a staff member. While client was preparing to go on an outing on September 23, 2024, the client was exiting the facility with staff following close behind. The staff member following got in front of the client and the gate with arms out and advised the client to go back inside the home. The staff member was able to clear up the miscommunication and the client went out on his outing like planned (See LIC 9102-Technical Advisory). LPA educated the Program Administrator regarding Personal Rights and the importance of Personal Rights in the facility and the population that they serve. Program Administrator reported to the LPA that the staff member will be trained on Personal Rights.

No deficiencies were cited during today's Case Management-Incident Inspection. Exit interview was conducted and a copy of this report was signed and emailed to the Program Administrator due to printer issues.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE: DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/01/2024
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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