198320089-4-3-2024-11-AS-EMAZ-D45N25-20240408100410

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320089
Report Date: 02/07/2024
Date Signed: 04/03/2024 05:29:02 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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/02/2024 and conducted by Evaluator Alfonso Iniguez

COMPLAINT CONTROL NUMBER: 11-AS-20240202093615

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: 114	DATE:	02/07/2024
		UNANNOUNCED	TIME BEGAN:	09:14 AM
MET WITH:	Casey Ferreras/Senior Caregiver		TIME COMPLETED:	02:05 PM

ALLEGATION(S):

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Staff yelled at a resident.
Staff handled a resident in a rough manner.
Staff did not respond to a resident's call for assistance in a timely manner.
Staff did not follow reporting requirements.

INVESTIGATION FINDINGS:

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This report serves as an amendment to clarify the findings. It does not supersede the complaint investigation findings reflected in the report created on 2/7/2024.

On 2/7/2024 LPA Alfonso Iniguez conducted an unannounced complaint visit. LPA Iniguez met with Trace Mallaret /Administrator. LPA explained the purpose of this visit.

Investigation Consisted of: LPA conducted the following interviews: Residents interviews (R#1-R#10) and Staff Interviews(S#1-S#10). LPA obtained and reviewed the following documents: Resident’s roster, Personnel roster, (R#1-R#5) Identification and Emergency Information, (R#1-R#5) Admissions agreements, (R#1-R#5) Physicians Report for Residential Care Facilities for the Elderly, (R#1-R#5) Needs and Services Plan, (R#1-R#5) Medication Administration Record (MAR) for the month of January 2024, copies of SRI’s dated on 2/3/24 and copy of Report Information and Victims’ Bill of Rights by Los Angeles Sherrif Department dated on 2/3/24.

Evaluation Report continues LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso Iniguez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024

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 4

Control Number 11-AS-20240202093615

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: MERRILL GARDENS AT ROLLING HILLS ESTATES	FACILITY NUMBER: 198320089
	VISIT DATE: 02/07/2024

NARRATIVE

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This report serves as an amendment to clarify the findings. It does not supersede the complaint investigation findings reflected in the report created on 2/7/2024.

Investigation Revealed the Following:

Allegation(s):Staff yelled at a resident.

The details of the complaint alleged that facility staff yelled at a resident in care.

During an interview with resident 1 (R#1), they stated that when (S#1) arrived at (R#1)’s room, (S#1) started to yell at (R#1), saying, “Get up.” (S#1) stated that they suffer from a physical illness that impedes them to get up on their own.

During interviews with residents (R#2-R#10), (8) out of (10) residents stated that they have never been yelled at or screamed at by facility staff. Also, (9) out of (10) residents stated that they feel safe interacting with the facility staff.

During interviews with staff (S#1-S#10), (10) out (10) facility staff stated that they have never yelled or screamed at a resident in care.

Staff handled a resident in a rough manner.

The details of the complaint alleged that facility staff handled resident in a rough manner while in care.

During an interview with resident 1 (R#1), they stated that when (S#1) stated that they suffer from a physical illness that impedes them to get up on their own. When (S#1) was trying to lift (R#1), they were screaming and pulling (R#1)’s shirt. (S#1) could not lift (R#1) from their chair, so they requested assistance from another caregiver. When the other caregiver arrived, (S#1) left (R#1)’s room.

During interviews with residents (R#2-R#10), (9) out of (10) residents stated that they have never been handled roughly by facility staff. Also, (9) out of (10) residents stated that they feel safe living at the facility. In addition, (9) out of (10) residents stated that no facility staff ever forced them to do what they didn’t want to.

During interviews with staff (S#1-S#10), (10) out (10) facility staff stated that they have never handled a rough manner a resident in care.

Evaluation Report continues LIC 9099-C

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso Iniguez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20240202093615

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: MERRILL GARDENS AT ROLLING HILLS ESTATES	FACILITY NUMBER: 198320089
	VISIT DATE: 02/07/2024

NARRATIVE

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This report serves as an amendment to clarify the findings. It does not supersede the complaint investigation findings reflected in the report created on 2/7/2024.

Staff did not respond to a resident's call for assistance in a timely manner.

The details of the complaint alleged that the facility staff is taking long time to attend the residents’ calls.
During an interview with resident 1 (R#1), they stated that (R#1) stated that on the night of 1/31/24, they requested assistance from a facility staff (S#1), but the facility staff did not arrive after 30 minutes.

During interviews with residents (R#2-R#10), (8) out of (10) residents stated that they had used the facility’s signal system, and it took less than five minutes or almost immediately for the facility staff to tend to the call.

During interviews with staff (S#1-S#10), (10) out (10) facility staff stated that it takes them approximately five minutes to tend to the call from the signal system in the resident’s room. Also, (10) out of (10) facility staff stated that no staff member has ever taken more than 30 minutes to respond to a call from the signal system coming from the resident’s room.

Staff did not follow reporting requirements.
The details of the complaint alleged that the facility did not report to CCLD past incidents involving residents in care.
During the records review, LPA Iniguez observed a Special Incident Report (SRI) regarding (R#1) event dated 2/1/24. A copy of the SRI was provided to LPA Iniguez during this visit.

During an Interview with staff (S#1-S#10), (10) out of (10) facility staff stated that the facility reports special incidents involving residents in care to CCLD.

Evaluation Report continues LIC 9099-C

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso Iniguez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 11-AS-20240202093615

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: MERRILL GARDENS AT ROLLING HILLS ESTATES	FACILITY NUMBER: 198320089
	VISIT DATE: 02/07/2024

NARRATIVE

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This report serves as an amendment to clarify the findings. It does not supersede the complaint investigation findings reflected in the report created on 2/7/2024.

During this investigation, LPA found did not find sufficient evident to support the above-mentioned allegations.

Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation(s) is/are found to be UNSUBSTANTIATED.

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.

According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe deficiencies therefore no citations were issued during this visit.

An exit interview was conducted, and a copy of the Complaint Report was given to Casey Ferreras / Senior Caregiver.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso Iniguez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024

LIC9099 (FAS) - (06/04)

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