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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 515002770
Report Date: 10/02/2024
Date Signed: 10/02/2024 04:31:38 PM

Document Has Been Signed on 10/02/2024 04:31 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 - FRANKLINFACILITY NUMBER:
515002770
ADMINISTRATOR/
DIRECTOR:		AGEE, KENNETHFACILITY TYPE:
737
ADDRESS:2888 FRANKLIN ROADTELEPHONE:
(760) 571-0953
CITY:YUBA CITYSTATE: CAZIP CODE:
95993
CAPACITY: 4CENSUS: 2DATE:
10/02/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:20 PM
MET WITH:Erin DucheneTIME VISIT/
INSPECTION COMPLETED:
04:40 PM
NARRATIVE
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Licensing Program Analyst (LPA) Hiratsuka conducted this unannounced visit in response to a California Department of Developmental Service (DDS) inspection on 08/27/2024.

On 08/27/2024, DDS observed the following:
-The facility has an Automated External Defibrillator that was found out of compliance. The report did not specify how the AED was not in compliance. LPA spoke to Administrator Kenneth Agee on the phone during today's visit and was informed the AED was not in compliance because there were no checks for operation. Title 22 requires it to have operation checks and there are none.
-The second issue is a container that stored used syringes and other medical sharps that DDS stated was stuck open. LPA interviewed Administrator on the phone who stated the container was stored in a box in the medication cart and the key to the box on the medication cart was lost and they had to get a new key to get the container out but stated the sharp container was not stuck open. LPA interviewed several staff who stated they were present and stated the sharp container was not open but it was full, but not a hazard. LPA cannot prove or disprove either version of events.
-The third issue involves a resident who is diabetic. There was one incident where the resident's blood sugar was extremely high and the resident refused to take insulin and go to the hospital and instead wanted to walk. The resident asserted their right to refuse insulin and go to the hospital. Eventually the resident did to go the emergency room for the high blood sugar. The licensee has since come up with a plan to address the issue with the resident. LPA suggested to have meetings with the resident to go over the diabetic condition and consequences for not acting on too high or too low blood sugar readings and have several different plans to talk the resident into cooperating.

The following deficiency is cited on LIC 809D and cited from the California Health and Safety Code. Failure to correct the deficiency may result in civil penalties. Exit interview conducted and appeal rights provided.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE: DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/02/2024
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 10/02/2024 04:31 PM - It Cannot Be Edited


Created By: Kerry Hiratsuka On 10/02/2024 at 04:13 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 - FRANKLIN
FACILITY NUMBER: 515002770

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/02/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/01/2024
Section Cited
CCR
80075.1(a)(3)(C)

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Automated External Defibrillators (AEDS). In an adult community care facility, a licensee is permitted to maintain and operate an AED at the facility if all of the following requirements are met: The licensee shall maintain at the facility the following: A log of checks of operation of the AED containing the dates
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By 11/01/2024, the licensee shall submit a plan stating how they shall ensure the AED has operational checks and the proper log.
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checked and the name of person checking. This requirment is not met as evidenced by: Based on interviews the licensee did not do operational checks and log them per the regulations which poses a possible health and safety 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.
SUPERVISOR'S NAME:Troy Ordonez
LICENSING EVALUATOR NAME:Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE:
DATE: 10/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/02/2024


LIC809 (FAS) - (06/04)
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