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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 015600255
Report Date: 01/15/2025
Date Signed: 01/15/2025 03:18:41 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/09/2025 and conducted by Evaluator Gregory Clark
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20250109083518
FACILITY NAME:MERCY RETIREMENT & CARE CENTERFACILITY NUMBER:
015600255
ADMINISTRATOR:MCCARRON, KATHLEENFACILITY TYPE:
741
ADDRESS:3431 FOOTHILL BOULEVARDTELEPHONE:
(510) 534-8540
CITY:OAKLANDSTATE: CAZIP CODE:
94601
CAPACITY:160CENSUS: 67DATE:
01/15/2025
UNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Kathleen McCarron, Executive DirectorTIME COMPLETED:
02:20 PM
ALLEGATION(S):
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Staff did not provide resident food in a timely manner.
Staff are not providing resident with an adequate amount of food.
INVESTIGATION FINDINGS:
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On 1/15/2025 at 12:50 PM, Licensing Program Analysts (LPAs) Greg Clark and Ardalan Gharachorloo arrived unannounced to conduct an initial 10-day complaint investigation and deliver findings in regard to the allegations above. LPAs met with Executive Director, Kathleen McCarron and explained the purpose of the visit.

During the course of the investigation LPAs interviewed W1 and S1. LPAs also visited and interviewed R1 in her room at the facility.

W1 stated that he was worried that R1 was not receiving enough food in a timely manner. W1 further stated that he spoke to facility staff about the issue and now understands that since R1 is receiving the end of life care and she often refuses to open her mouth to eat or take her medications. W1 further stated that he is satisfied with the care that R1 is receiving at the facility.

**CONTINUED ON 9099C**
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2025
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 2
Control Number 15-AS-20250109083518
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: MERCY RETIREMENT & CARE CENTER
FACILITY NUMBER: 015600255
VISIT DATE: 01/15/2025
NARRATIVE
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**CONTINUES FROM 9099**

LPAs interviewed S1. S1 stated that R1 is currently on hospice and receiving the end of life care. There was a period of time that R1 did not eat for five days. S1 further reported that R1 often refuses to open her mouth to accept food, drink and medications. S1 also reported that staff make every effort to encourage R1 eat and drink but are often unsuccessful. S1 is confident that R1 is receiving an adequate amount of food in a timely manner as tolerated.

This agency has investigated the complaint alleging staff did not provide resident food in a timely manner and staff are not providing resident with an adequate amount of food. We have found that the complaint was unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview conducted, a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2