198320089-2-1-2023-11-AS-MVAO-CRVSG3-20230516135117

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320089
Report Date: 02/01/2023
Date Signed: 02/01/2023 12:33:38 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 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
01/23/2023 and conducted by Evaluator Lourdes Montoya

COMPLAINT CONTROL NUMBER: 11-AS-20230123082158

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:	02/01/2023
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	WILL CARTER		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Food is served cold
Food is not prepared in a safe/healthful mamanner
Staff are not observing personal hygiene and food services sanitation practices which protect the food from contamination

INVESTIGATION FINDINGS:

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On 2/1/2023, Licensing Program Analyst (LPA) Lourdes Montoya conducted a subsequent complaint visit at this facility to gather additional information and deliver complaint investigation findings. LPA Montoya called and conducted a risk assessment with Administrator Will Carter who confirmed one resident is under isolation. LPA met with Administrator Will Carter who assisted with the visit. LPA explained the purpose of the visit.

The investigation consisted of the following: On 1/30/23, LPA Montoya conducted a tour of the inside and outside grounds of the facility. LPA interviewed seven (7) staff and ten (10) residents. LPA requested and obtained client roster, staff roster, food menu, and other pertinent records.

Report continued in LIC 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Lourdes Montoya	TELEPHONE: (510) 725-7918
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20230123082158

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: MERRILL GARDENS AT ROLLING HILLS ESTATES	FACILITY NUMBER: 198320089
	VISIT DATE: 02/01/2023

NARRATIVE

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INVESTIGATIONS REVEALED:

Allegation: Food is served cold.

It is alleged food is served cold. LPA interviewed seven (7) staff and ten (10) residents. Based on interviews conducted, six (6) residents and two (2) staff revealed food is served cold while four (4) residents and five (5) staff revealed food is not served cold. Three residents (R1, R4, and R5) stated food is rarely served hot; Two residents (R2 and R8) and five staff ( S2, S3, S4, S6 and S7) stated what is hot is served hot; One resident (R3) stated R3 has not been served cold food that is supposed to be hot, but R3 heard other residents have complained that food is served cold what is supposed to be hot; One resident (R6) stated the food is served at an acceptable temperature; Three residents (R7, R9 and R10) stated sometimes food is served cold. And two staff (S1 and S5) revealed that there are residents who complained that hot food was served cold. Based on interviews conducted there is no sufficient evidence to corroborate the above allegation.

Allegation: Food is not prepared in a safe/healthful manner

It is alleged food is not prepared in a safe/healthful manner. LPA interviewed seven (7) staff and ten (10) residents. Based on interviews conducted, all seven staff (S1-S7) and all ten residents (R1-R10) denied food is not prepared in a safe/healthful manner. Based on interviews conducted there is no evidence to corroborate the above allegation.

Allegation: Staff are not observing personal hygiene and food services sanitation practices which protect the food from contamination

It is alleged staff are not observing personal hygiene and food services sanitation practices which protect the food from contamination. LPA interviewed seven (7) staff (S1-S7) and ten (10) residents (R1-R10). Based on interviews conducted, all seven staff and nine out of ten residents denied staff are not observing personal hygiene and food services sanitation practices which protect the food from contamination. One resident (R5) stated staff don’t wear gloves when serving residents with food and R5 questions whether the dining tables are sanitized or not. Based on interviews conducted, there is no sufficient evidence to corroborate the above allegation.

REPORT CONTINUED IN LIC 9099C

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Lourdes Montoya	TELEPHONE: (510) 725-7918
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2023

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20230123082158

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: MERRILL GARDENS AT ROLLING HILLS ESTATES	FACILITY NUMBER: 198320089
	VISIT DATE: 02/01/2023

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32	Based on information gathered, the preponderance of evidence standard has not been met. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are Unsubstantiated. Exit interview was conducted with Administrator Will Carter and a hard copy was provided.

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Lourdes Montoya	TELEPHONE: (510) 725-7918
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2023

LIC9099 (FAS) - (06/04)

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