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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320089
Report Date: 09/29/2020
Date Signed: 09/30/2020 11:22:43 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:MERRILL GARDENS AT ROLLING HILLS ESTATESFACILITY NUMBER:
198320089
ADMINISTRATOR:DEBBIE INFIELDFACILITY TYPE:
740
ADDRESS:627 SILVER SPUR RDTELEPHONE:
(310) 750-9877
CITY:ROLLING HILLS ESTATESTATE: CAZIP CODE:
90274
CAPACITY:150CENSUS: 0DATE:
09/29/2020
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:ADMINISTRATOR DEBBIE INFIELDTIME COMPLETED:
05:00 PM
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On 09/28/2020 around 1pm Licensing Program Analysts (LPAs) Jose Calderon and LPA Ulysses Coronel conducted an announced telephonic visit via face time with Administrator Debbie Infield for purpose of a pre-licensing evaluation. The requested capacity is for 135 non-ambulatory and 15 bedridden for a total of 150 Residential Care Facility for Elderly (ages 60 and above).

Facility is a 114 bedroom, 115 bathrooms and 7 public bathrooms, four-story building. The facility has Media Room, Tech Room, laundry room, beauty salon run by a third party. The resident bedrooms are spacious and will easily accommodate the resident’s furnishings. There is a large backyard with a multiple covered patio for shade. The patio contained multiple small tables and multiple couches. Outdoor passageways, walkways, driveways, steps and patios are free from obstructions. LPAs did not observe hazards, such as ladders, gardening tools and/or motorized equipment in the front, back and/or side areas of the facility. There are no smoking sections found. Residents Bedrooms: All Bedrooms are for non-ambulatory clients. Toured all 114 bedrooms from floor 1 to 3 broken down between studio’s, 1 bedroom and 2 -bedroom apartments. There are 94 rooms in assisted living and 20 rooms in the memory care unit, one of which is a shared apartment..

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jose CalderonTELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: MERRILL GARDENS AT ROLLING HILLS ESTATES
FACILITY NUMBER: 198320089
VISIT DATE: 09/29/2020
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The facility has furnished show rooms for the LPA s review. Per the Administrator stated residents will bring their own furniture when they move-in but the facility can provide furniture if needed as there is a contract with Furniture company for emergency backup. Received Cort Furniture packages for 1 & 2 bed rooms and studio’s which can be delivered overnight. Bathrooms: Have a working toilet, wash basins, and has a walk-in shower tub with grab bars. LPAs observed adequate lighting in hallway leading to bathrooms. Linens & Hygiene Supplies: Linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads were limited in quantity. There very limited supplies of linen stored in laundry room. Received email from administrator 09/29/2020 confirming extra linens have been purchased from Target for facility.

Emergency Phone Numbers, Exit Plan & Menu: The telephone system is a land line and operable. Emergency Disaster Plan and "See something, say something Let Us Know" were noted, but the size of the poster did not meet title 22. Administrator purchased from Fed-X printing a larger poster that meets title 22 guide lines. Fire Extinguishers were mounted on the wall in hallway though out the facility.


Food Service’s No non-perishable food was found other than a 7-day emergency food supply. Received Sysco Invoice for food delivery on 09/29/2020. Smoke Detectors: Multiple hard-wired smoke detectors are found in the facility. Carbon monoxide detector located and mounted throughout the facility is operational.
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jose CalderonTELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2020
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: MERRILL GARDENS AT ROLLING HILLS ESTATES
FACILITY NUMBER: 198320089
VISIT DATE: 09/29/2020
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Appliances: Two large commercial kitchens located on the first and second floors, noted working kitchens, and noted 2 commercial laundry rooms with, washer, and dryer, working sinks. The residences are equipped with central air and heat and each client’s bedroom is individually climate controlled. Water Temperature: Bathrooms water temperature, kitchen water temperature was tested though out the facility and averaged 115 F. degrees. Medications, First-Aid Kit & Book: Medication administration records storage area, and first aid kit has been inspected, which are stored in locked kitchen cabinet in the nurse’s office, available for authorized staff but inaccessible to unauthorized staff and residents.

Clients & Staff Files: Records of staff and clients shall be stored in a locked in the administrator office which is locked has been inspected.


Reading Material, Games, Equipment & Materials: The facility has a robust activity board and on-line TV monitor of activities for clients. LPAs did not observe any pet or bodies of water at the facility. LPAs did not observe delayed egress, chain locks or dead bolts on exits. LPAs did not observe pad locks or other mechanisms which may be obstructions for safe and quick egress during an emergency on side gates and front exits. Pool/Jacuzzi & Pets: LPAs did not observe any pet or bodies of water at the facility. Fire clearance: Fire Clearance was approved on 5/20/2020 for 135 non-ambulatory residents with no special instructions and 15 bedridden residents. LPAs did not observe pad locks or other mechanisms which may be obstructions for safe and quick egress during an emergency on side gates and front exits or emergency exits


SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jose CalderonTELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2020
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: MERRILL GARDENS AT ROLLING HILLS ESTATES
FACILITY NUMBER: 198320089
VISIT DATE: 09/29/2020
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LPA Calderon will review Component III: (1pm on 09/29/2020) about how to operate the facility within substantial compliance with Administrator Debbie Infield.

An exit interview was conducted, and a copy of this report has been furnished to the applicant via email. Due to time constraints LPA will complete report on a later date.
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jose CalderonTELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2020
LIC809 (FAS) - (06/04)
Page: 4 of 4