019200879-11-29-2020-15-AS-KHOS-BVWLAD-20201202073457

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200879
Report Date: 11/29/2020
Date Signed: 11/29/2020 01:46:39 PM

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
07/02/2020 and conducted by Evaluator Rolanda Pitcher

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20200702204337

FACILITY NAME:	MERRILL GARDENS AT ROCKRIDGE		FACILITY NUMBER:	019200879
ADMINISTRATOR:	DANIEL SLAUGHTER		FACILITY TYPE:	740
ADDRESS:	5238 CORONADO AVE		TELEPHONE:	(510) 338-4543
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94618
CAPACITY:	150	CENSUS: 114	DATE:	11/29/2020
		UNANNOUNCED	TIME BEGAN:	11:06 AM
MET WITH:	Yolanda Harrell		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Facility has pests.

INVESTIGATION FINDINGS:

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On 7/28/20, at 1:35 PM, Licensing Program Analyst (LPA) Rolanda Pitcher open a complaint regarding the above allegation. A Tele-Visit was conducted with Executive Director, Daniel Slaughter at that time. On 11/29/20, LPA spoke with Resident Care Director, Yolanda Harrell to deliver complaint findings.

On 7/28/20 conducted an interview via telephone with the complainant prior to the investigation. The complainant denied seeing the presence of rodents, roaches or any other kind of pest in the facility. Therefore, LPA determined the allegation is unfounded. A finding that the complaint is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

Exit interview conducted with Yolanda Harrell

Unfounded

Estimated Days of Completion: 30

SUPERVISOR'S NAME: Julio Montes	TELEPHONE: (510) 286-0518
LICENSING EVALUATOR NAME: Rolanda Pitcher	TELEPHONE: (510) 542-0253
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2020

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 3

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
07/02/2020 and conducted by Evaluator Rolanda Pitcher

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20200702204337

FACILITY NAME:	MERRILL GARDENS AT ROCKRIDGE		FACILITY NUMBER:	019200879
ADMINISTRATOR:	DANIEL SLAUGHTER		FACILITY TYPE:	740
ADDRESS:	5238 CORONADO AVE		TELEPHONE:	(510) 338-4543
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94618
CAPACITY:	150	CENSUS: 114	DATE:	11/29/2020
		UNANNOUNCED	TIME BEGAN:	11:06 AM
MET WITH:	Yolanda Harrell		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff did not properly dispose of trash.

INVESTIGATION FINDINGS:

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Licensing Program Analyst, (LPA) Rolanda Pitcher conducted an investigation regarding the above mentioned. On 11/29/20, LPA spoke with Resident Care Director, Yolanda Harrell to deliver complaint findings. On 11/18/20, LPA conducted an interview with S2, S3, S4. S2 stated the facility have 2 garbage areas for residents on the 3rd and 4th floor in the resident storage area and they have a key to get in that area. The resident can only recycle in that area and staff go by twice a day and dispose the trash in the refuse area. S3 stated due to COVID-19 precautionary guidelines the dining area was not open, therefore, food trays were delivered to each resident room and there were 3 to 4 trash bins per floor in the storage unit for residents to dispose their empty food containers.

S3 stated "we definitely had a routine going on making sure the trash was emptied every hour."

Report continued on LIC 9099C

Unsubstantiated

Estimated Days of Completion: 30

SUPERVISOR'S NAME: Julio Montes	TELEPHONE: (510) 286-0518
LICENSING EVALUATOR NAME: Rolanda Pitcher	TELEPHONE: (510) 542-0253
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2020

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 15-AS-20200702204337

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: MERRILL GARDENS AT ROCKRIDGE	FACILITY NUMBER: 019200879
	VISIT DATE: 11/29/2020

NARRATIVE

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S4 stated while the dining room was closed due to COVD-19, safety precautions were in place. Residents food were brought in cartoons to their room. All of staff were fully masked and gloved. "If the resident was on care we took the food into their room and the other residents that were on there own we rang their doorbell to notify them their meals were ready."

S4 stated as for garbage disposal, maintenance and other staff would go in the rooms and remove any food that was on the counter or in the trash. There were also 4 trash bins that were placed outside of the rooms on the floors and they too were emptied four (4) times a day. "Everyone wore a mask, gloves and used a trash bin and worked collectively to ensure resident were safety."

Although the allegation may have happened or may be valid, there is not a preponderance of evidence to prove the alleged violation, did or did not occur, therefore the allegation is unsubstantiated.

Exit interview was conducted with Yolanda Harrell

SUPERVISOR'S NAME: Julio Montes	TELEPHONE: (510) 286-0518
LICENSING EVALUATOR NAME: Rolanda Pitcher	TELEPHONE: (510) 542-0253
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2020

LIC9099 (FAS) - (06/04)

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