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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455920054
Report Date: 11/18/2024
Date Signed: 11/18/2024 02:42:48 PM

Document Has Been Signed on 11/18/2024 02:42 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 ALTURASFACILITY NUMBER:
455920054
ADMINISTRATOR/
DIRECTOR:		BATES, DAMEYAFACILITY TYPE:
735
ADDRESS:20785 OLD ALTURAS ROADTELEPHONE:
(530) 222-5633
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY: 5CENSUS: 5DATE:
11/18/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:15 PM
MET WITH:Administrator, Dameya BatesTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
NARRATIVE
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On November 18, 2024 at approximately 10:00 AM, Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at Merakey - Old Alturas for the purpose of conducting a Case Management-Incident Inspection. Upon arrival, LPA was greeted at the door by, Administrator, Dameya Bates, and was granted access into the facility.

During the Case Management-Incident Inspection, LPA reviewed the SOC 341 and interviewed the Administrator. LPA learned that the alleged staff member slid the unlocked room door shut on a client that was having a behavioral episode so that the client can stop screaming. Client was able to open the door and leave the room (See LIC 809D). However, this presents a Personal Rights risk to the client(s) in care as this was utilized as an ineffective technique to get the client to calm down. LPA educated the Administrator regarding Personal Rights and to ensure that Personal Rights are afforded to ALL clients in care.

Deficiencies cited from the California Code of Regulations, Title 22, Division 6, Chapter 1 of California Regulation. Appeal rights were provided. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties. Exit interview was conducted, and a copy of this report was signed and given to the Administrator along with Appeal Rights.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE: DATE: 11/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/18/2024
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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Document Has Been Signed on 11/18/2024 02:42 PM - It Cannot Be Edited


Created By: Farhaan Sarangi On 11/18/2024 at 12:47 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: MERAKEY - OLD ALTURAS
FACILITY NUMBER: 455920054

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/19/2024
Section Cited
CCR
80072(a)(3)

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80072 Personal Rights:
(a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following:

(3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including but not limited to: interference with the daily living functions, including eating, sleeping, or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.

This requirement was not as evidenced by:
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Administrator shall submit an LIC 9098-Self Certification regarding the importance of ensuring that clients are receiving Personal Rights in the facility. In addition, Administrator/Licensee shall submit a plan for future compliance to the LPA by November 19, 2024.
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Based on an interview that was conducted, LPA learned that the alleged staff member slid the unlocked room door shut on a client that was having a behavioral episode so that the client can stop screaming which presents an immediate health, safety and personal rights risk to the client(s) in care.
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Licensee/Administrator shall provide staff training to staff who provide care and supervision to clients in care.

POC due date by: November 25, 2024

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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.
SUPERVISOR'S NAME:Lauren Crocker
LICENSING EVALUATOR NAME:Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE:
DATE: 11/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/18/2024


LIC809 (FAS) - (06/04)
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