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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 515002770
Report Date: 05/20/2022
Date Signed: 05/20/2022 12:40:20 PM

Document Has Been Signed on 05/20/2022 12:40 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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:MERAKEY - FRANKLINFACILITY NUMBER:
515002770
ADMINISTRATOR:RODRIGUEZ, VANESSAFACILITY TYPE:
737
ADDRESS:2888 FRANKLIN ROADTELEPHONE:
(760) 571-0953
CITY:YUBA CITYSTATE: CAZIP CODE:
95993
CAPACITY: 4CENSUS: 4DATE:
05/20/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Vanessa Rodriguez, AdministratorTIME COMPLETED:
12:45 PM
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On 5/20/2022, Licensing Program Analysts (LPAs) Mai Thao and Talwinder Bains and Licensing Program Manager (LPM) Laura Munoz conducted an unannounced case management to follow-up on a visit that was conducted on 3/23/2022 by the Department of Developmental Services (DDS). LPAs and LPM met with Vanessa Rodrigues, Administrator and explain purpose of visit.

Prior to initiating the case management visit, LPAs and LPM completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPAs and LPM ensured they wash their hands before entering the facility and the following Personal Protective Equipment (PPE) was worn: N95 and surgical mask. In addition, Staff screened LPA and LPM prior to entering the facility.

On 3/23/2022, through record review, it was observed by DDS that Client 1 (C1) and Client 2 (C2) medical conditions were not consistently stable. It was observed through record review that C1 was sent to the Emergency Room 7 times and 1 time to Urgent care from 1/18/2022 to 3/18/2022. It was also observed that C2 was sent to the Emergency Room 4 times from 2/19/2022 to 2/20/2022. During the review, it was observed that the medical services for clients in care were either not scheduled or provided and/or documented within the clinical chart.

DDS observed in C1 and C2 Restricted Health (RH) Care Plan that the plan did not address all restricted health care conditions. Both C1 and C2 RH Plan did not indicate whether both clients have the ability to perform the procedures for their own RH conditions.

(Continue 809-C........).

SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Mai Thao
LICENSING EVALUATOR SIGNATURE: DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/20/2022
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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: MERAKEY - FRANKLIN
FACILITY NUMBER: 515002770
VISIT DATE: 05/20/2022
NARRATIVE
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 It was also observed that each RH condition did not indicate if it requires a licensed professional staff or unlicensed staff to perform the procedures. It was also observed that C1 utilizes oxygen therapy, and the Licensee did not have written documentation reporting to the local fire jurisdiction that oxygen is in use at the facility. C1 stated in interviews that C1 is not able to operate C1 inhalation devices and the facility is not ensuring that the inhalation devices are operated for by skilled licensed professional.

Through record review of facility medication records, it was observed that on 10/26/2021, Client 3 (C3) was given a medication by error. On 12/28/2022 and 1/20/2022 C1 did not receive C1’s prescribed medications. It was also observed that on 1/30/2022 C1 received a prescribed medications by error.

Through interviews conducted by DDS and Merakey – Franklin Staff, the Licensee has not been able to employ a Registered Dietitian to provide nutritional support services for clients with special diets. During the review, it was observed that the facility First Aid Kit contained a scissor and was placed in an unsecured area; which was removed and placed in a secure location. It was also observed that a thermometer was not located in the first aid kit. During today's visit, the facility was observed to have working thermometers kept at the front entrance that is available when one is needed.

Based on these findings, the following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22, and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted and appeal rights provided.

SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Mai Thao
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2022
LIC809 (FAS) - (06/04)
Page: 2 of 5
Document Has Been Signed on 05/20/2022 12:40 PM - It Cannot Be Edited


Created By: Mai Thao On 05/20/2022 at 10:18 AM
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
, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: MERAKEY - FRANKLIN
FACILITY NUMBER: 515002770

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/20/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/21/2022
Section Cited
CCR
80092.1(d)

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80092.1 General Requirements for Restricted Health Conditions (d) Either the client's medical condition is chronic and stable, or is temporary in nature and is expected to return to a condition normal for that client. This requirement has not been met as evidenced by:
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Licensee agrees to submit a date by POC that the licensee agrees to submit a plan to the Department that will address how Licensee can ensure clients in care restricted health condition are stable. Date of plan should not be more than 30 days from this report.
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Based on observations and record review, Licensee did not ensure that C1 and C2 condition is stable, C1 was sent to ER 7 times and Urgent Care 1 time and C2 was sent to the hosptal 4 times, this poses an immediately health and safety or personal rights risk to clients in care
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Type A
05/21/2022
Section Cited
CCR80075(a)

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80075 Health Related Services (a) The licensee shall ensure that each client receives necessary first aid and other needed medical or dental services, including arrangement for and/or provision of transportation.... This requirement has not been met as evidenced by:
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Licensee agrees to submit a date by POC that the licensee agrees to submit a plan to the Department that will address how Licensee can ensure that clients medical or dental services are scheduled, provided and/or documented. Date of plan should not be more than 30 days from this report.
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Based on record review, Licensee did not ensure that clients in care medical services were either scheduled or provided and/or documented within the clinical chart which poses an immediately health and safety or personal rights risk to clients 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.
SUPERVISOR'S NAME:Troy Ordonez
LICENSING EVALUATOR NAME:Mai Thao
LICENSING EVALUATOR SIGNATURE:
DATE: 05/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/20/2022


LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 05/20/2022 12:40 PM - It Cannot Be Edited


Created By: Mai Thao On 05/20/2022 at 10:25 AM
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
, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: MERAKEY - FRANKLIN
FACILITY NUMBER: 515002770

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/20/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/21/2022
Section Cited
CCR
80092.2(a)

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80092.2 Restricted Health Condition Care Plan (a) If the licensee of an ARF chooses to care for a client with a restricted health condition... the licensee shall develop and maintain...a written Restricted Health Condition Care Plan. The plan must include all of the following: (1)-(8). This requirement has not been met as evidenced by:
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Licensee agrees to submit a date by POC that the licensee agrees to submit a plan to the Department that will address how Licensee can ensure restricted health care plans are completed and current prior to accepting a client with a RH condition and/or when a client develop a RH care condition and updated as necessary.
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Based on record review, Licensee did not ensure that clients in care restricted health care plan addressed all restricted health conditions that included (1)-(8), which poses an immediate health and safety or personal rights risks to clients in care.
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Date of plan should not be more than 30 days from this report.
Licensee also agrees to submit in completed and updated restricted health care plans for all clients in care with a restricted health care conditions to meet 80092.2(a)(1)-(8) along with staff schedule by 6/30/2022.
Type A
05/21/2022
Section Cited
CCR80075(b)

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80075 Health Related Services (b) Clients shall be assisted as needed with self-administration of prescription and nonprescription medications.

This requirement has not been met as evidenced by:
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Licensee agrees to submit a date by POC that the licensee agrees to submit a plan to the Department that will address how Licensee can ensure clients are assisted with prescribed medications. Date of plan should not be more than 30 days from this report.
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Based on record reviews and interviews, Licensee did not ensure that Clients prescription medications were given as directed which poses an immediate health and safety or personal rights risks to clients in care
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Licensee also agrees to conduct training with staff and agrees to submit in training materials and signatures of attendees to Licensing by 6/30/2022
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:Troy Ordonez
LICENSING EVALUATOR NAME:Mai Thao
LICENSING EVALUATOR SIGNATURE:
DATE: 05/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/20/2022


LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 05/20/2022 12:40 PM - It Cannot Be Edited


Created By: Mai Thao On 05/20/2022 at 10:30 AM
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
, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: MERAKEY - FRANKLIN
FACILITY NUMBER: 515002770

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/20/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/27/2022
Section Cited
CCR
80075(e)(2)(A)

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80075 Health Related Services (e) In adult CCFs, when a client requires oxygen the licensee is responsible for the following: (2) Ensuring that the following conditions are met if oxygen equipment is in use: (A)The licensee makes a written report to the local fire jurisdiction that oxygen is in use at the facility. This requirement has not been met as evidence by:
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Licensee agrees to submit a written report to the local fire jurisdiction reporting usage of oxygen at the facility along with a copy of facility sketch indicating which room oxygen is being used by 6/30/2022
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Based on record review, Licensee did not ensure to notify a written local fire department that oxygen is in use at the facility which poses a potential health and safety or personal rights risk to clients in care.
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Licensee also agrees to submit in a copy of the report to Licensing by 6/30/2022
Type B
05/27/2022
Section Cited
CCR80076(a)(6)(A)

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80076 Food Services (a) In facilities providing meals to clients, the following shall apply: ( 6) Modified diets prescribed ...shall be provided. (A) The licensee shall obtain and follow instructions from the physician or dietitian on the preparation of the modified diet. This requirement has not been met as evidenced by:
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Licensee agrees to submit a date by POC that the licensee agrees to submit a plan to the Department that will address how Licensee can ensure clients with modified diets are provided nutritonal support by the physician or dietitian to Licensing.
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Based on interviews and record review, Licensee did not ensure that there is a Registered Dietitian to provide nutritional support services for clients with special diets which poses a potential health and safety or personal rights risk to clients in care.
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 Date of plan should not be more than 30 days from this report.
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:Troy Ordonez
LICENSING EVALUATOR NAME:Mai Thao
LICENSING EVALUATOR SIGNATURE:
DATE: 05/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/20/2022


LIC809 (FAS) - (06/04)
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