019200879-9-5-2023-15-AS-YFLS-CVEL6S-20230906082914

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200879
Report Date: 09/05/2023
Date Signed: 09/05/2023 11:48:00 AM

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
06/23/2023 and conducted by Evaluator Lisha Holmes

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20230623145451

FACILITY NAME:	MERRILL GARDENS AT ROCKRIDGE		FACILITY NUMBER:	019200879
ADMINISTRATOR:	REDDY, ANNA		FACILITY TYPE:	740
ADDRESS:	5238 CORONADO AVE		TELEPHONE:	(510) 338-4543
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94618
CAPACITY:	150	CENSUS: 120	DATE:	09/05/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Anna Reddy, Administrator		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Staff engaging in inappropriate behavior while in the presence of residents.

INVESTIGATION FINDINGS:

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On 09/05/23 around 10:00 AM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to deliver the complaint finding for the above allegation. LPA met Anna Reddy, Administrator (ADM) and explained the purpose of the visit.

During the investigation, LPA toured the facility with S2 and S5. LPA conducted resident, staff and witness interviews. LPA requested a current Resident Roster, Staff Roster, LIC 500, Training Records for four (4) Staff (S7, S8, S9, S10) and Emergency and Identification contact sheets for Residents (R1, R2).

Continued on LIC9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Yvonne Flores-Larios	TELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Lisha Holmes	TELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2023

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

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20230623145451

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: 09/05/2023

NARRATIVE

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...continued from LIC9099

Allegation: Staff engaging in inappropriate behavior while in the presence of residents.
UNSUBSTANTIATED

LPA conducted interviews with Staff (S1, S2, S3, S4, S5, S6, S10, S11), Residents (R1, R2, R3, R4, R5, R6) and Witness #1 (W1). S10 stated that several residents and staff members have heard S4 and S5 engaging in inappropriate behavior in the office and in the presence of residents. Interviews with Staff (S1, S2, S3, S4, S5, S6, S10, S11) revealed that they had heard rumors about S4 and S5; no staff stated that they had heard or witnessed S4 and S5 engaging in inappropriate behavior in the presence of residents. R5 stated that he/she thinks there’s a strong possibility of the allegation but would not go into details. R1, R2, R3, R4, R6 and W1 were not aware of the allegation and never witnessed S4, S5 or other Staff engaging in inappropriate behavior in the presence of residents. LPA and S1 discussed scheduling meetings with Staff and Residents to mitigate the spread of rumors at the facility in an effort to maintain good morale within the facility.

Although the allegation may have happened or is 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 and a copy of this report provided to ADM.

SUPERVISOR'S NAME: Yvonne Flores-Larios	TELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Lisha Holmes	TELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2023

LIC9099 (FAS) - (06/04)

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