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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 275202591
Report Date: 12/09/2022
Date Signed: 12/16/2022 09:46:57 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 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
05/08/2020 and conducted by Evaluator Sarah Hurt
COMPLAINT CONTROL NUMBER: 26-AS-20200508115514
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: 108DATE:
12/09/2022
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Administrator, Tiffany SantoroTIME COMPLETED:
12:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not provide adequate fluids to residents.
Staff are falsifying medication administration records.
Staff are falsifying medication label instructions.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Sarah Hurt arrived at the facility on 12/09/2022 unannounced to deliver findings on the above allegations. LPA Hurt met with Administrator Tiffany Santoro and explained the purpose of today's visit.
Regarding the allegation Staff do not provide adequate fluids to residents. Based on interviews conducted with facility residents and staff during this investigation this facility is providing adequate fluids to residents. LPA interviewed three facility staff who all stated they encourage and remind residents to hydrate. LPA interviewed four facility residents who all stated they have never had any issues with hydration. Resident 1 stated they have no problems with care or hydration provided. Therefore, this complaint is UNSUBSTANTIATED. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Continued on 9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Sarah HurtTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2022
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 26-AS-20200508115514
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: MERRILL GARDENS AT MONTEREY
FACILITY NUMBER: 275202591
VISIT DATE: 12/09/2022
NARRATIVE
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...Continued from 9099

Regarding the allegation Staff are falsifying medication administration records. Based on interviews conducted with facility staff during this investigation the facility is not falsifying medication administration records. LPA interviewed three facility staff, all three stated they have never witnessed anyone falsifying medication records. Staff 1 stated they never change the labels. If the doctor makes a change in the medication per the doctor's order, they will update the MAR instructions. The pharmacy will usually update the prescription and send a new prescription out. Therefore, this complaint is UNSUBSTANTIATED. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Regarding the allegation Staff are falsifying medication label instructions. Based on interviews conducted with facility staff during this investigation the facility is not falsifying medication label instructions. LPA interviewed three facility staff, all three stated they have never witnessed any falsifying of medication labels. Staff 2 stated they are unaware of any facility staff altering medication records or labels. Therefore, this complaint is UNSUBSTANTIATED. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

No deficiencies were cited per Title 22 Regulations. Exit interview conducted with Administrator Tiffany Santoro, and a copy of this report was left at the facility along with appeals rights provided.

SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Sarah HurtTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 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
05/08/2020 and conducted by Evaluator Sarah Hurt
COMPLAINT CONTROL NUMBER: 26-AS-20200508115514

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: 108DATE:
12/09/2022
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Administrator, Tiffany SantoroTIME COMPLETED:
12:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not administer medications according to physician orders.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Sarah Hurt arrived at the facility on 12/09/2022 unannounced to deliver findings on the above allegations. LPA Hurt met with Administrator Tiffany Santoro and explained the purpose of today's visit.

Regarding the allegation Staff do not administer medications according to physician orders. LPA reviewed facility Medication Administration Records (MAR). The facility MAR did document medication errors for Resident 1, and Resident 2 in the months of April and May 2020. Therefore, this complaint is SUBSTANTIATED. LPA Hurt did document a Technical Advisory during this visit.

No deficiencies were cited per Title 22 Regulations. Exit interview conducted with Administrator Tiffany Santoro, and a copy of this report was left at the facility along with appeals rights provided.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Sarah HurtTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3