019200879-6-29-2022-15-AS-KHOS-CG9L7X-20220712083103

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200879
Report Date: 06/29/2022
Date Signed: 06/29/2022 05:26:14 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
01/24/2022 and conducted by Evaluator Catherine Lin

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20220124150642

FACILITY NAME:	MERRILL GARDENS AT ROCKRIDGE		FACILITY NUMBER:	019200879
ADMINISTRATOR:	CANDICE MOSES		FACILITY TYPE:	740
ADDRESS:	5238 CORONADO AVE		TELEPHONE:	(510) 338-4543
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94618
CAPACITY:	150	CENSUS: 127	DATE:	06/29/2022
		UNANNOUNCED	TIME BEGAN:	01:35 PM
MET WITH:	Parinda Kleinberg, Resident Care Director		TIME COMPLETED:	05:40 PM

ALLEGATION(S):

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Facility staff failed to seek timely medical attention for resident
Resident care needs are not being met
Staff mismanaged resident's medication

INVESTIGATION FINDINGS:

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On 6/29/2022 at 1:35pm, Licensing Program Analyst (LPA) C. Lin conducted an unannounced subsequent complaint investigation visit of the allegations listed above. LPA met with Resident Care Director Parinda Kleinberg and explained the purpose of the visit.

Allegation: Facility staff failed to seek timely medical attention for resident - Unsubstantiated
The Department has investigated this allegation and per record review and interviews found that R1 is fully alert, R1’s wound was not developed in facility, R1’s physician was aware of it, and prescription was prescribed to R1. R1 stated that proper care was received by staff members timely. When R1 asked for assistance by using call button, staff member arrived in approximately 15 minutes during daytime and 10 minutes at night. S1 stated that caregivers would not provide wound care to resident based on the California Regulation Code of Title 22. However, Med-Tech S2 and S4 were trained to provide basic care consistently on R1’s wound based on physician’s order.
Continue on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) -62-2621
LICENSING EVALUATOR NAME: Catherine Lin	TELEPHONE: 510-622-2053
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2022

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-20220124150642

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: 06/29/2022

NARRATIVE

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Allegation: Resident care needs are not being met - Unsubstantiated
The Department has investigated this allegation and per records review and interviews found that staff R2, R3, R4, R5, and R6 have been providing same care to R1 based on what R1 needs. R1 confirmed that the care needs including but not limited to ADL, dressing, mediations were met.

Allegation: Staff mismanaged resident's medication - Unsubstantiated
The Department has investigated this allegation and per records review and interviews found that facility has made afford to communicate with physician for the order (Bacitracin). W1 also confirmed that multiple requests were received from facility and responded to facility multiple times between 1/10/21 and 1/19/22. Facility received the physician's order on 1/20/22 and assisted R1 to administer medication as soon as receiving it on the same day which was documented on R1's MAR.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to provide the alleged violation did occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview conducted with Director and a copy of this report provided.

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) -62-2621
LICENSING EVALUATOR NAME: Catherine Lin	TELEPHONE: 510-622-2053
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2022

LIC9099 (FAS) - (06/04)

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