198320089-10-19-2023-11-AS-JHAD-CYFQL8-20231212111532

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320089
Report Date: 10/19/2023
Date Signed: 10/19/2023 12:55:04 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/21/2022 and conducted by Evaluator Perry Scott

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20221221111340

FACILITY NAME:	MERRILL GARDENS AT ROLLING HILLS ESTATES		FACILITY NUMBER:	198320089
ADMINISTRATOR:	DEBBIE INFIELD		FACILITY TYPE:	740
ADDRESS:	627 SILVER SPUR RD		TELEPHONE:	(310) 750-9877
CITY:	ROLLING HILLS	STATE: CA	ZIP CODE:	90274
CAPACITY:	150	CENSUS: 112	DATE:	10/19/2023
		UNANNOUNCED	TIME BEGAN:	12:24 PM
MET WITH:	Tracey Mallaret		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Facility staff did not properly transfer resident causing resident to fall.
Facility staff did not respond to residents call button in a timely manner.
Facility staff not maintaining residents hygiene.

INVESTIGATION FINDINGS:

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On 10/11/23, at 9:40am, Licensing Program Analyst (LPA) Perry Scott initiated a complaint investigation to obtain additional information regarding the allegations listed above. LPA met with Tracey Mallaret, General Manager, and explained the purpose of today’s visit.

On 10/11/23, the investigation consisted of the following:

During today’s visit LPA toured the facility. LPA requested the following records: Resident roster, staff roster, resident record (Physicians report, ID/Emergency Information, Showering Schedule, Staff training in transferring/Fall Risk for residents, Call Log, Assessment and Needs Plan, Preplacement Appraisal Plan, MAR, and Progress notes). LPA interviewed staff (S1-S5) and residents (R1-R10).

The investigation revealed the following- Allegation # 1 Facility staff did not properly transfer resident causing resident to fall.

Report continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Perry Scott	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023

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 3

Control Number 11-AS-20221221111340

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: MERRILL GARDENS AT ROLLING HILLS ESTATES	FACILITY NUMBER: 198320089
	VISIT DATE: 10/19/2023

NARRATIVE

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On 10/11/23, from 09:40am-2:00pm, LPA interviewed S1-S5 & R1-R10. It is alleged that the staff did not properly transfer R1 causing resident to fall. 5 of 5 staff denied the allegation that the Facility staff did not properly transfer resident causing resident to fall. All staff stated that they are properly trained at transferring residents and maintain that their actions did not result in the resident to fall. LPA reviewed staff records for in-service training for residents who are a fall risk. All staff have verified training in “tending to falls/lifting techniques” for residents and are compliant in annual required trainings for staff. LPA interviewed R1-R10 about the allegation and 10 of 10 residents stated that they were happy with the care and supervision provided by the staff.

Based on interviews, there is insufficient evidence to support the allegation that Facility staff did not properly transfer resident causing resident to fall. 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.

Allegation # 2 Facility staff did not respond to residents’ call button in a timely manner.

LPA interviewed S1-S5 & R1-R10. It is alleged that the staff does not answer calls for assistance in a timely manner. 5 of 5 staff denied the allegation that the Facility staff did not respond to residents’ call button in a timely manner. All staff stated that all calls are answered within 10 minutes of receiving the call. LPA interviewed R1-R10 about the allegation and 9 of 10 residents stated that the staff does answer their calls in a timely manner and are happy with the care and supervision.

Based on interviews, there is insufficient evidence to support the allegation that Facility staff did not respond to residents’ call button in a timely manner. 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.

Allegation # 3 Facility staff not maintaining residents’ hygiene.

LPA interviewed S1-S5 & R1-R10. It is alleged that R1 is taking a shower every other day. 5 of 5 staff denied the allegation that Facility staff not maintaining residents’ hygiene. All staff state that there is a shower schedule, and according to the residents’ care plan, they choose the date to take a shower.

Report continued on LIC9099-C

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Perry Scott	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20221221111340

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: MERRILL GARDENS AT ROLLING HILLS ESTATES	FACILITY NUMBER: 198320089
	VISIT DATE: 10/19/2023

NARRATIVE

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LPA reviewed R1’s care plan and shower schedule and R1 is scheduled to take a shower on Sundays, Tuesdays, Thursdays, and Saturdays. LPA interviewed R1-R10 about the allegation and 3 of 10 residents stated that they are satisfied with the shower schedule in their care plan. And 7 of 10 residents stated that they don’t need assistance with their hygiene needs and they take their own showers without assistance.

Based on interviews, there is insufficient evidence to support the allegation that Facility staff not maintaining residents’ hygiene. 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.

No deficiencies were cited.

An exit interview was conducted, and a copy of this report was given to Tracey Mallaret, General Manager.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Perry Scott	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023

LIC9099 (FAS) - (06/04)

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