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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320089
Report Date: 03/17/2023
Date Signed: 03/17/2023 05:37:40 PM


Document Has Been Signed on 03/17/2023 05:37 PM - 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 ESTATESFACILITY NUMBER:
198320089
ADMINISTRATOR:DEBBIE INFIELDFACILITY TYPE:
740
ADDRESS:627 SILVER SPUR RDTELEPHONE:
(310) 750-9877
CITY:ROLLING HILLSSTATE: CAZIP CODE:
90274
CAPACITY:150CENSUS: 105DATE:
03/17/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Will Carter, Operations SpecialistTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) conducted an unannounced case management incident visit to the above facility. LPA met with Will Carter, Operations Specialist and the purpose of the visit was explained.

LPA received an SIR dated 02/21/23, reporting that facility was possibly going to evict R#1 for nor complying with medication management. R#1 was not taking the medication as prescribed. Family requested that facility take over with R#1 medication management. The facility was trying to arrange an appointment with family to reassess R#1. The family was not cooperating with the facility. On 02/24/23, facility finally started reassess R#1, but R#1 did not want to cooperate with the medicine portion of the reassessment. The facility informed family they couldn't complete the reassessment R#1, facility would begin eviction process.

LPA advised facility to speak with family and/or R#1 to see why are R#1 is not taking their medicine as prescribed. Operations specialist spoke with R#1, they are working with PCP, to change some of the medication that is causing some swelling to R#1. The facility decided to not go forward with the eviction process.

An exit interview was conducted with Will Carter, Operations Specialist and copy of report provided.
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana SotoTELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:
DATE: 03/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/17/2023
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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