019200879-10-17-2022-15-AS-YFLS-CKQMTT-20221031095405

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200879
Report Date: 07/11/2022
Date Signed: 10/17/2022 05:55:35 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 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
08/27/2021 and conducted by Evaluator Catherine Lin

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20210827145908

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:	07/11/2022
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Lisa Read, Business Office Director		TIME COMPLETED:	02:36 PM

ALLEGATION(S):

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Neglect/Lack of Supervision

INVESTIGATION FINDINGS:

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On 7/11/22 at approximately 2:30pm, Licensing Program Analyst (LPA) C. Lin arrived unannounced to deliver findings for the above allegation and met with Business Office Director Lisa Read and explained the purpose of visit.

On 8/30/2021, LPA Allison O’Hollaren initiated 10-day investigation. On 10/14/2021, this complaint was reassigned to LPA Luisa Fontanilla.

During the course of investigation, the Department conducted interviews and reviewed records such as incident reports, staff schedule for the month of June 2021, Resident 1 (R1) Emergency Information, Physician’s Report, Admission Agreement and Task Log for June 2021.

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: 07/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2022

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-20210827145908

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: 07/11/2022

NARRATIVE

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When interviewed, R1 denied anyone kissed R1 at the facility. All staff interviewed state that S1 did not work with R1 and had minimal interactions and would only see R1 in the common areas such as dining room and living room.

S1 denied kissing R1 and explained that S1 had minimal interactions with S1 and would only speak with S1 in the dining room.

In addition, Former Resident Care Coordinator states that S1 could not tell who kissed S1. Staff denied ever seeing S1 act inappropriately with other staff or any of the residents including R1.
Based on interviews conducted, the allegation that R1 was sexually abused – kissed and hugged by a facility male staff (S1) is unsubstantiated.

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.

There is no deficiency noted.

Exit interview conducted with Business Office 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: 07/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2022

LIC9099 (FAS) - (06/04)

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