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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320089
Report Date: 01/13/2026
Date Signed: 01/13/2026 03:00:09 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
10/03/2025 and conducted by Evaluator Mario Leon
COMPLAINT CONTROL NUMBER: 11-AS-20251003084145
FACILITY NAME:MERRILL GARDENS AT ROLLING HILLS ESTATESFACILITY NUMBER:
198320089
ADMINISTRATOR:TRACEY E HOLDERFACILITY TYPE:
740
ADDRESS:627 SILVER SPUR RDTELEPHONE:
(310) 974-3339
CITY:ROLLING HILLSSTATE: CAZIP CODE:
90274
CAPACITY:150CENSUS: 106DATE:
01/13/2026
UNANNOUNCEDTIME BEGAN:
08:57 AM
MET WITH:Tracey Mallaret - General ManagerTIME COMPLETED:
03:58 PM
ALLEGATION(S):
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Staff did not meet resident's hygiene care needs resulting in a unknown skin condition to resident in care
Staff did not meet resident's dental hygiene care needs
Staff left resident in soiled clothing
INVESTIGATION FINDINGS:
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On 01/13/26 Licensing Program Analyst (LPA) Mario Leon conducted a subsequent complaint visit at the facility. LPA was met by staff one, Tracey Mallaret - General Manager (S1) and the purpose of the visit was explained.
The investigation consisted of the following:
On 10/08/25 LPA requested and received the following documents: resident and staff rosters, staff schedule for the months of September and October of 2025 (09/25 & 10/25). LPA also requested six (6) resident documents (R1-R6), listed as follows: face sheets (emergency ID) (dated: varioius), physician reports (LIC602a) (dated:various), needs and services plan (dated: various) and care logs of these 6 residents in care. LPA interviewed six (6) residents (R1 through R4 & R6), R5 is non-verbal and therefore LPA was unable to interview R5, and two (2) staff (S1-S2). On 01/13/26 LPA interviewed three (3) staff (S3-S5) and conducted further record review.

Report continues, please see LIC 9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2026
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 2
Control Number 11-AS-20251003084145
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: 01/13/2026
NARRATIVE
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Regarding the allegation "Staff did not meet resident's hygiene care needs resulting in a unknown skin condition to resident in care.", it is being alleged that a resident is suffering from a "burn and peel" on their face. Interviews revealed that all five staff (S1-S5) and all five residents (R1-R5) have not agreed the allegation has taken place. Record reviews revealed that residents' care plan and service logs align and no discrepancies were observed. Based on record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated.

Regarding the allegation "Staff does not ensure that resident's dental hygiene needs are being met.", it has been alleged that a resident was observed with dirty teeth. Interviews revealed that all five staff (S1-S5) and all five residents (R1-R5) have not agreed the allegation has taken place. Record reviews revealed that for residents' care plan indicating full-assist with brushing teeth do match their service logs. Futhermore, staff have indicated that they can easily tell those who have not brushed their teeth and when noticed, prompting and assisting with brushing has become the normal pattern. Based on record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated.

Regarding the allegation "Staff left resident in soiled clothing.", it is being alleged that a resident was observed in dirty clothing on multiple occasions. Interviews revealed that all five staff (S1-S5) and all five residents (R1-R5) have not agreed the allegation has taken place. Furthermore, staff three (S3) stated, "If we see a resident wearing anything soiled, we make sure to swap their clothing." Based on record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated.

There have been zero (0) deficiencies cited during today's visit.

An exit interview was held with Tracey Mallaret and a copy of this report has been provided.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2