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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603348
Report Date: 12/14/2023
Date Signed: 12/14/2023 02:44:17 PM


Document Has Been Signed on 12/14/2023 02:44 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 CNTR DR. ST 500
MONTEREY PARK, CA 91754



FACILITY NAME:MERRILL GARDENS AT WEST COVINAFACILITY NUMBER:
198603348
ADMINISTRATOR:FISCHER, SHERRYFACILITY TYPE:
740
ADDRESS:1400 WEST COVINA PKWYTELEPHONE:
(626) 587-4318
CITY:WEST COVINASTATE: CAZIP CODE:
91790
CAPACITY:150CENSUS: 114DATE:
12/14/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Sherry FischerTIME COMPLETED:
03:00 PM
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LPA Nune Margaryan conducted Case management visit for follow up possible concern about grab bars in the residents’ bathrooms.

LPA met with Sherry Fischer and explained the purpose of the visit. At the time of visit LPA toured the facility and check the Grab Bars in the randomly selected rooms: #201, Room #206, Room #303, Room #315, Room #319.

LPA observed that all the bathrooms are equipped with grab bars and measurements are in compliance under ADA requirements.

No deficiencies observed.

Exit interview conducted with Sherry Fischer and copy of the report is provided.

SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3378
LICENSING EVALUATOR NAME: Nune MargaryanTELEPHONE: 323-981-3378
LICENSING EVALUATOR SIGNATURE:
DATE: 12/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/14/2023
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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