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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 02:42:04 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:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Administrator, Dameya BatesTIME VISIT/
INSPECTION COMPLETED:
01:45 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 Required 1 year inspection. Upon arrival, LPA was greeted at the door by, Administrator, Dameya Bates, and was granted access into the facility.

LPA and the Administrator toured the facility. LPA observed the facility to be clean, safe and sanitary with all exits free from obstruction. Fire Extinguishers was last inspected on November 2024. All carbon monoxide detectors were tested and found to be operational at the time of the inspection. Smoke Detectors sound directly to the Local Fire Jurisdiction. Hot water temperature measured at 106 degrees in 2 of 2 clients bathrooms. Hot water temperature is within acceptable range of 105-120 degrees. LPA observed sufficient perishable and non-perishable foods located in the fridge. Food menu was observed and found to be appropriate during the inspection. There was ample space for personal hygiene products, bedding and linens, utensils, dishes, and cook ware. Client records, personnel records, medication were locked in separate cabinets, toxins are kept locked and inaccessible to clients in care. Facility has a first aid kit which was inspected and found to be appropriate during the inspection. There is an outdoor space for activities with a shaded area. During the Required 1 year inspection, LPA advised facility to contact County Public Health and Community Care Licensing immediately if symptoms of COVID-19 + or any infectious diseases in the facility. Emergency Disaster Plan was reviewed during the inspection. Emergency Disaster Drill has not been conducted for over a year (See LIC 809D) Infection Control Plan is currently being modified and will be sent to CCL once completed (See LIC 9102-Technical Violation).

During the Required 1 year inspection, LPAs reviewed 5 of 5 staff files and found those files to be appropriate. LPA reviewed 5 of 5 client files and found those to be appropriate during the inspection. 5 of 5 client medication orders were reviewed and found to be appropriate during the inspection. (Report continued on LIC 809C)
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 11/18/2024
NARRATIVE
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LPA requested the following documents to be sent:

LIC 500- Personnel Report
LIC 308- Designation of Facility Responsibility
LIC 309- Administrative Organization
Most up-to-date Liability insurance
Updated Infection Control Plan
Control of Property
Register of clients

Deficiencies cited from the California Code of Regulations, Title 22, Division 6, Chapter 6 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
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 12:59 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

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1565(c)
Other Provisions
(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of individuals served by the facility is not required during a drill. While a facility may provide an opportunity for individuals served by the facility to participate in a drill, it shall not require that participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and, if applicable, the names of staff participating in the drill.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in that the facility has not conducted a quarterly Emergency Disaster Drill which poses a potential health, safety or personal rights risk to the clients in care.
POC Due Date: 11/25/2024
Plan of Correction
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Administrator shall fill out an LIC 9098 understanding of the regulation, conduct staff training and provide a statement on how future compliance shall be met.

POC due date: November 25, 2024.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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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