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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 455920054
Report Date: 06/12/2025
Date Signed: 06/12/2025 01:39:15 PM

Substantiated


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
04/16/2025 and conducted by Evaluator Kayla Adkison
PUBLIC
COMPLAINT CONTROL NUMBER: 59-AS-20250416151918
FACILITY NAME:MERAKEY - OLD ALTURASFACILITY NUMBER:
455920054
ADMINISTRATOR:BATES, DAMEYAFACILITY TYPE:
735
ADDRESS:20785 OLD ALTURAS ROADTELEPHONE:
(530) 222-5633
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY:5CENSUS: DATE:
06/12/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Jessica Boarman, AdministratorTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff did not distribute residents' medications as prescribed.
INVESTIGATION FINDINGS:
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On June 12, 2025, Licensing Program Analyst (LPA), Kayla Adkison arrived at the facility unannounced to deliver final findings regarding a complaint that was received on April 16, 2025. LPA met with Jessica Boaman, Administrator and explained the purpose of the visit.

Allegation: Staff did not distribute residents' medications as prescribed.

During the interview process, the administrator advised that the allegation did happen. The administrator reported that the facility’s Licensed Vocational Nurse (LVN) was required to administer the residents’ medications; however, during the evening shift, the LVN clocked out and left the facility without distributing medications. The staff person that came on shift after the LVN, was not aware that the residents did not receive their evening medications. The administrator reported that overall, there were no adverse reactions from the residents not receiving their medications.
CONTINUED ON LIC 9099-C


Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Kayla Adkison
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2025
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 4
Control Number 59-AS-20250416151918
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 ALTURAS
FACILITY NUMBER: 455920054
VISIT DATE: 06/12/2025
NARRATIVE
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Based on investigation observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations, (Title 22), is cited on the attached LIC 9099D.

Exit interview conducted. A copy of this report and Appeal Rights were provided.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Kayla Adkison
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 59-AS-20250416151918
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 ALTURAS
FACILITY NUMBER: 455920054
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/12/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/13/2025
Section Cited
CCR
80065(f)(4)
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80065(f)(4) Personnel Requirements – All personnel shall be given on-the-job training or shall have related experience which provides knowledge of and skill in the following areas, as appropriate to the job assigned and as evidenced by safe and effective job performance. Assistance with prescribed medications which are self-administered. This
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The administrator agrees to submit in writing by end of business 06/13/2025 a plan to the licensing agency as to how this type of deficiency will be avoided in the future.
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This requirement was not met as evidenced by: Based on interviews and records reviewed, the licensee/administrator did not ensure that residents were provided their evening medications. This poses an immediate 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: Lauren Crocker
LICENSING EVALUATOR NAME: Kayla Adkison
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2025
LIC9099 (FAS) - (06/04)
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