079201165-3-7-2024-15-AS-KHOS-D46LVZ-20240409090623

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079201165
Report Date: 03/07/2024
Date Signed: 03/07/2024 02:28:17 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
03/05/2024 and conducted by Evaluator Laura Hall

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20240305143658

FACILITY NAME:	MERRILL GARDENS AT BRENTWOOD		FACILITY NUMBER:	079201165
ADMINISTRATOR:	SHIELDS, JERYL		FACILITY TYPE:	740
ADDRESS:	2600 BALFOUR RD		TELEPHONE:	(925) 297-6841
CITY:	BRENTWOOD	STATE: CA	ZIP CODE:	94513
CAPACITY:	150	CENSUS: 120	DATE:	03/07/2024
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Lydia Hertzler, Executive Director		TIME COMPLETED:	02:35 PM

ALLEGATION(S):

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Staff does not prevent residents from falling in the shower.

Facility does not have a backup generator.

INVESTIGATION FINDINGS:

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On 3/7/2024 9:45am, Licensing Program Analysts (LPAs), L. Hall and T. Syess-Gibson arrived unannounced to conduct the 10-day initial visit for the above allegations. LPAs met with Lydia Hertzler, Executive Director (ED), and explained the reason for the visit.

During the visit LPAs interviewed the Reporting party (RP), staff, residents, obtained and reviewed LIC500 (personnel record), resident roster, the crisis/emergency manual, and a copy of the monthly emergency checks, and an admission agreement.

Allegation: Facility does not have a backup generator.

The RP stated during interview that the facility does not have a backup generator. During interview with Staff 1 (S1) and Staff 2 (S2) it was stated that the facility has a inverter that has large battery packs that gives electricity for 90 minuets.

Continued on LIC9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Laura Hall	TELEPHONE: (510) 622-2024
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024

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-20240305143658

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: 03/07/2024

NARRATIVE

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Continued from LIC9099.

During interview with Staff 1 (S1) and Staff 2 (S2) it was stated that the facility has an inverter that has large battery packs to give electricity for 90 minuets. S1 stated staff was informed that residents should be moved within an hour if power is out after the 90 minuets. S1 also stated the common areas, the lights in the apartments are dimly lit and the kitchen equipment still works when the inverter is working. S2 showed LPAs where the inverter is located during the visit. S2 stated that he completes safety training with all new employees. Based on the investigation the above allegations are unsubstantiated.

Allegation: Staff does not prevent residents from falling in the shower.

RP stated during initial interview some residents have concerns about other residents falling while exiting the shower and that additional grab bars should be installed. LPAs toured an apartment with and without the extra grab bars. S1 stated that the residents are offered a referral to have grab bars installed by a contractor at an additional cost. Review of the admission agreement indicates any alterations and maintenance has to be given written approval prior to any physical changes, which would include the installation of additional grab bars. The residents that were interviewed did have concerns about falling when exiting the shower but felt they should not be responsible for paying a contractor that is referred from the facility to install additional grab bars.

Based upon the information obtained during investigation. The above allegations are unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview conducted and a copy of this report provided,

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Laura Hall	TELEPHONE: (510) 622-2024
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024

LIC9099 (FAS) - (06/04)

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