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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320089
Report Date: 10/25/2021
Date Signed: 10/25/2021 12:20:48 PM

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 HILLSSTATE: CAZIP CODE:
90274
CAPACITY:150CENSUS: 81DATE:
10/25/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:07 AM
MET WITH:Debbie InfieldTIME COMPLETED:
12:38 PM
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Licensing Program Analyst (LPA) Ulysses Coronel conducted an unannounced Annual required visit with a primary focus on infection control measures. LPA was met by Debbie Infield, Administrator and the purpose of today’s visit was explained. The facility is licensed to serve residents age range 60 and over, with a capacity of 150 non-ambulatory, 15 bedridden and hospice waiver for up to 15 hospice residents. There are currently 81 resident in placement, 13 residents are non- ambulatory and 1 hospice resident. The facility consists of 114 bedrooms, 115 bathrooms and 7 public bathrooms, and is a 4-story building. The facility has Media Room, Tech Room, laundry room, and a beauty salon run by a third party.

LPA and administrator toured the physical plant. There are no bodies of water or firearm/ammunition on the premises. Client rooms were checked. Beds and bedding were in good condition, adequate lighting provided, storage for client personal belongings was observed. Walls and floors were in good repair. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured at 118.4.1F. A comfortable temperature is maintained in the facility. LPA observed the facility to be clean and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning agents, toxins, and sharps were inaccessible to residents. The kitchen was inspected and there is a enough perishable and non-perishable food available which is stored properly. Fire extinguishers were charged, the most recent fire inspection was conducted on 07/28/2021. During the visit, LPA observed the facility infection control practices. LPA observed screening protocols for visitors, staff and residents, sanitizing stations ( Located in common areas and restrooms). LPA observed staff and residents were wearing face coverings and required postings throughout the facility. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). LPA advised the Administrator to continuously monitor the Centers for Disease Control (CDC) website and Community Care Licensing Provider Informational Notices (PIN) for any updates relating to COVID-19 guidance. There were no deficiencies observed during today’s visit, an exit interview was held and a copy of the report was provided.
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ulysses CoronelTELEPHONE: (951) 212-8917
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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