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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201165
Report Date: 10/12/2023
Date Signed: 10/12/2023 10:41:13 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
06/30/2023 and conducted by Evaluator Jill Clancy-Czuleger
COMPLAINT CONTROL NUMBER: 15-AS-20230630083003
FACILITY NAME:MERRILL GARDENS AT BRENTWOODFACILITY NUMBER:
079201165
ADMINISTRATOR:SHIELDS, JERYLFACILITY TYPE:
740
ADDRESS:2600 BALFOUR RDTELEPHONE:
(925) 297-6841
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY:150CENSUS: 111DATE:
10/12/2023
UNANNOUNCEDTIME BEGAN:
08:53 AM
MET WITH:Lydia Hertzler, General Manager TIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Staff sexually harassed resident in care
Staff did not safe guard resident's personal belongings
INVESTIGATION FINDINGS:
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On 10/12/2023 at 8:53 AM, Licensing Program Analysts (LPA), J. Clancy-Czuleger arrived unannounced to deliver complaint findings for the above allegations. LPA met with Lydia Hertzler, General Manager and explained the reason for the visit. During the course of investigation, LPA obtained information, collected documents and interviewed 6 staff and 3 residents.

On the allegation facility Staff did not safeguard resident's personal belongings. Interviews with R1 she stated that the necklace that went missing was a recent gift from a friend. R1 stated that she did not add it to the personal properties and valuables form before it had gone missing. In an interview with S1 they stated that they had been made aware that there was a necklace and that it had gone missing but could not verify the existence of the necklace as it had not been seen by any staff.

Continued on LIC 9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Jill Clancy-CzulegerTELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023
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-20230630083003
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 BRENTWOOD
FACILITY NUMBER: 079201165
VISIT DATE: 10/12/2023
NARRATIVE
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... Continued from LIC 9099

On the allegation Staff sexually harassed resident in care. Interviews with R1 stated that she has been made to feel uncomfortable by S2 when he made a comment about seeing her in her swimsuit and stating that he wanted to see her in it again. In an interview with S2, they stated that the situation was not as described, that there were actually two different conversations. In the first conversation R1 stated that she was on her way to the pool, and she was going to “make others drool” because she was younger than the other residents and was something to look at. In the second conversation, S2 made a comment about calling him to her room any time to hear the noise that fridge was making that R1 was upset that it had not been fixed, S2 tried to defuse the situation by saying “hope they were not drooling over you like you said”.

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 and a copy of this report provided.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Jill Clancy-CzulegerTELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2