198603348-8-11-2023-28-AS-RORN-CV8PD8-20230831111308

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603348
Report Date: 08/11/2023
Date Signed: 08/11/2023 04:40:11 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/13/2023 and conducted by Evaluator Erik Zaragoza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230113110457

FACILITY NAME:	MERRILL GARDENS AT WEST COVINA		FACILITY NUMBER:	198603348
ADMINISTRATOR:	FISCHER, SHERRY		FACILITY TYPE:	740
ADDRESS:	1400 WEST COVINA PKWY		TELEPHONE:	(206) 676-5300
CITY:	WEST COVINA	STATE: CA	ZIP CODE:	91790
CAPACITY:	150	CENSUS: 109	DATE:	08/11/2023
		UNANNOUNCED	TIME BEGAN:	09:39 AM
MET WITH:	Sherry Fischer - Administrator		TIME COMPLETED:	04:55 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff have not fixed residents shower
Staff speak disrespectfully to residents
Staff did not meet residents needs

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Erik Zaragoza conducted a follow up complaint investigation regarding the allegations listed above. LPA met with Sherry Fischer the Administrator and explained the reason for the visit.

The investigation revealed the following: during the initial visit conducted on 01/20/2022, LPA Kruz Long LPA obtained/reviewed a copy of the Staff/Resident rosters, work orders and interviewed two staff members in the conference room. During today's visit, LPA Zaragoza interviewed Residents 1 - 12 (R1, R2, R3, R4, R5, R6, R7, R8, R9, R10, R11, R12), and Staff #1 - 6 (S1, S2, S3, S4, S5, S6). LPA also obtained copies of the following documentation: Currest Staff and Resident Rosters for the facility, work orders for R1 and R2's room, and also the admission agreement for R1 and R2.

The investigation revealed the following: in regards to the allegation "Staff have not fixed resident's showers," it is alleged that the Maintenance Department had taken six months to fix the leaking shower head in the resident's restrooms, which was fixed on 1/19/2023.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2023

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 3

Control Number 28-AS-20230113110457

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: MERRILL GARDENS AT WEST COVINA	FACILITY NUMBER: 198603348
	VISIT DATE: 08/11/2023

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

During interviews with the Maintenance Director and the Administrator, it was shown in the facility's work order system that the most recent work order submitted for R1 and R2's room were from 3/7/2023, and therefore there was no work order submitted around the time that they requested their leaking shower head to get fixed. Additionally they explained that when a maintenance work order is received by them, it typically takes three (3) days to one (1) week to get fixed at the latest. R3 - R12 stated that they have never had any issues with maintenance when they have submitted work orders, and that their issues have been fixed in a timely manner. Five (5) out of (6) staff could not corroborate the allegation that it takes longer than one week at most to fix any type of maintenance issue in resident rooms.

In regards to the allegation "Staff speak to residents disrespectfully", it is alleged that staff have spoken down to residents in a condescending and disrespectful manner before and has caused tension between the residents and the staff. During interviews with the Administrator, she explained that neither she nor any of the other staff members of the facility have treated the residents in a disrespectful manner. The administrator states that the facility always reminds staff of their obligation to provide 5-star customer service to the residents and provide training as well to ensure that all residents are treated with dignity and respect when working with residents. R3 - R12 all stated that they have never witnessed staff being rude or disrespectful to the residents in any way, and R6 stated that that the staff provide exemplary and wonderful service to all the residents that live in the facility. Five (5) out of six (6) Staff members could not corroborate the allegation that they have ever witnessed staff speaking to residents in a rude or condescending manner.

In Regards to the allegation "Staff did not Meet Resident's Needs", it is alleged that staff have ignored the needs of residents and allowed them to wander, in particular R12 who lives in the memory care unit, and also because the grab bars that are installed in all of the resident's showers are inadequate and could potentially lead to a resident falling and thus leading to serious injury because the grab bars do not follow the American's with Disabilities Act (ADA) standards. Administrator explained that the needs of residents in the memory care unit are never ignored, and that she has conducted research with the facility's legal team who concluded the grab bars of the facility do meet the ADA standards. Interviews with R3 - R12 revealed that none of them had witnessed the needs of the memory care unit being ignored by the staff, and that they were all satisfied with the grab bars in their restroom, however R6 and R7 stated that they could foresee it being an issue with shorter residents. Five (5) out of six (6) staff members could not corroborate the allegation that the needs of memory care residents were not being met.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20230113110457

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: MERRILL GARDENS AT WEST COVINA	FACILITY NUMBER: 198603348
	VISIT DATE: 08/11/2023

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 statements and interviews conducted with staff, clients, review of client files and facility file records, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview held, and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 3