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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275202591
Report Date: 12/16/2020
Date Signed: 12/22/2020 09:45:03 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:MERRILL GARDENS AT MONTEREYFACILITY NUMBER:
275202591
ADMINISTRATOR:LAUREN M. POWELLFACILITY TYPE:
740
ADDRESS:200 IRIS CANYON RDTELEPHONE:
(831) 250-0930
CITY:MONTEREYSTATE: CAZIP CODE:
93940
CAPACITY:150CENSUS: 102DATE:
12/16/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Tiffaney SantoroTIME COMPLETED:
11:20 AM
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Licensing Program Analyst (LPA) Marybeth Donovan conducted a Technical Assist (TA) Visit via Zoom platform with Tiffaney Santoro General Manager/ Administrator, Ruby Perez Director of Activities and Barbara Elenteny Program Clinical Consultant Nurse, California Department of Social Services. The purpose of the visit was to provide technical assistance for Infection Prevention and Control guidelines for Adult and Senior Care facilities. LPA conducted a virtual tour of the facility. LPA and PCC reviewed the facility policies and procedures to include screening, disinfecting, staffing, training, emergency medical care, PPE usage, Doffing and Donning of PPE, supplies and resident activities.

The following recommendations were discussed:

1. Post Donning and Doffing signage outside and inside of Isolation room(s).
2. Staff sanitize hands after leaving Isolation room
3. Maintain covered trash can inside Isolation room for proper disposal of contaminated PPE.
4. Staff change face mask after leaving Isolation room.

LPA forwarded CDC signage for Donning and Doffing of PPE and informational Links on PPE usage.

Report reviewed with Tiffaney Santoro and copy emailed for signature purposes.
SUPERVISOR'S NAME: George NwaforTELEPHONE: (650) 269-7419
LICENSING EVALUATOR NAME: Marybeth DonovanTELEPHONE: (408) 726-4301
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE:
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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