198320089-11-16-2022-11-AS-ASOO-CL77E6-20221114203526

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198320089
Report Date: 11/14/2022
Date Signed: 11/16/2022 09:07:51 AM

Document Has Been Signed on 11/16/2022 09:07 AM - It Cannot Be Edited

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 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: 105	DATE:	11/14/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:05 PM
MET WITH:	Tracey Holder, General Manager		TIME COMPLETED:	03:00 PM

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Licensing Program Analyst (LPA) Ana Soto conducted an unannounced Annual required and infection control visit to the above facility. LPA was met by Tracy Holder, Executive Director and the purpose of today’s visit was explained.

There are currently (105) residents in the facility. (75) residents are ambulatory, (30) are non-ambulatory, (0) bedridden. The facility is a three-story structure located in a residential/commercial neighborhood. It consists (114) bedrooms, (124) bathrooms, garage level floor- Lobby, reception area, administrators offices, lounge, computer area, Theater, Activity room and office, Discovery room, Soiled room and Laundry room, storage room, Prep-Kitchen, Wellness room, Med room, Beauty salon, Refuge room, discovery room, 1st floor- Open Kitchen, Private dining room, Dining room. 2nd - Floor - lounge, refuge room. 3rd Floor - Refuge and housekeeping closet. Garden House (Memeory Care Unit) - laundry room, med room, kitchen, dining room, and living room. Shaded back patio and underground parking.

LPA, Tracy, and Mario toured the entire facility inside and out. Documents are posted as mandated.The Bedrooms are occupied by residents and contain the mandated furniture. 95 bathrooms have grab bars and non-skid flooring and are clean and operational. First aid kits is fully stocked with manual; smoke detectors and carbon monoxide detector were in compliance and operational inter-connected with sprinkler system. No firearms are stored at facility and no bodies of water present. Medications are stored, locked and inaccessible to residents. (3) Resident file along with medications are current. Ample supply of perishable and nonperishable food, hot water temperature is (118.1) degrees Fahrenheit, linens and personal hygiene supplies are adequate, hazardous toxins and/or sharp items are inaccessible to residents, 15 fire extinguisher are fully charged. Exit, walkways and/or passageways, front and back yard are free of debris and/or hazards. The facility is in good repair.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana Soto	TELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:	DATE: 11/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2022

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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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: 11/14/2022

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During the visit, LPA observed the facility infection control practices. LPA observed a sanitizing station at the facility entry & visitors and temperatures are logged and checked, sanitizer/soap, paper towels, in all the bathrooms and additional sanitation supplies are stored in storage rooms and Housekeeping closets. LPA observed staff masks, resident private rooms will be converted to isolation rooms (if needed) trash cans with lids, cart for PPE’s, mitigation plan posted and/or in folder, Fit testing completed for staff, and required postings throughout the facility. Visitor designated area, facility has internet & computers for residents to use, resident’s temperatures are checked and logged (twice a day). Emergency contacts updated and posted; PPE's are enough for 30 days. All residents and staff are vaccinated and boosted

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

No technical Advisory (TA) issued.

An exit interview conducted with Tracey Holder, General Manager and a hard copy of report provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana Soto	TELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:	DATE: 11/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2022

LIC809 (FAS) - (06/04)

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