275202591-4-1-2022-26-AS-SPIY-CDDN97-20220411101527

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 275202591
Report Date: 03/30/2022
Date Signed: 04/01/2022 09:14:17 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/08/2021 and conducted by Evaluator Shawna Doucette

COMPLAINT CONTROL NUMBER: 26-AS-20210708094801

FACILITY NAME:	MERRILL GARDENS AT MONTEREY		FACILITY NUMBER:	275202591
ADMINISTRATOR:	TIFFANEY SANTORO		FACILITY TYPE:	740
ADDRESS:	200 IRIS CANYON RD		TELEPHONE:	(831) 250-0930
CITY:	MONTEREY	STATE: CA	ZIP CODE:	93940
CAPACITY:	150	CENSUS: 102	DATE:	03/30/2022
		UNANNOUNCED	TIME BEGAN:	02:11 PM
MET WITH:	Administrator Tiffaney Santoro		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff do not treat resident with dignity
Garbage containers in facility do not have tight fitting covers
Facility has insects

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Shawna Doucette contacted the facility to commence a complaint investigation. LPA conducted a visit and took COVID-19 pre-cautionary measures. LPA identified herself and explained the purpose of the visit was to deliver findings to Administrator Tiffaney Santoro.

Based on staff and resident interviews, it is unknown if staff did not treat resident with digniity.

Based on interviews and observation, garbage containers that were observed have tight fitting covers.

Based on observation, interviews, record review from pest control agency it was found that the facility is treating any insect problem by using a pest control service. LPA obtained copies of pest control records.

Although the allegations Staff do not treat resident with dignity, Garbage containers in facility do not have tight fitting covers, Facility has insects may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.

An exit interview was conducted and a copy of this report was emailed to the Administrator.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Shawna Doucette	TELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022

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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