306005275-12-19-2023-22-AS-AORZ-CYQUFT-20231221143315

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005275
Report Date: 12/19/2023
Date Signed: 12/19/2023 11:34:41 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/14/2020 and conducted by Evaluator Jenifer Tirre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200914090403

FACILITY NAME:	MERRILL GARDENS AT HUNTINGTON BEACH		FACILITY NUMBER:	306005275
ADMINISTRATOR:	JOHNSON, JILL		FACILITY TYPE:	740
ADDRESS:	17200 GOLDENWEST ST		TELEPHONE:	(714) 842-6569
CITY:	HUNTINGTON BEACH	STATE: CA	ZIP CODE:	92647
CAPACITY:	150	CENSUS: 91	DATE:	12/19/2023
		UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Administrator, Jill Johnson		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Facility staff are physically abusing residents
Facility staff neglected resident
Administrator failed to address reports of abuse

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jenifer Tirre met with Executive Director Jill Johnson for the purpose of delivering findings for the above allegations. The investigation consisted of obtained records and interviews with Merrill Gardens staff, residents and witnesses.
On 9/14/2020 the department received allegations that facility staff are physically abusing residents, facility staff neglected resident and Administrator failed to address reports of abuse. The investigation was completed by the department and revealed the following:
Based on the interviews with staff four of four staff members stated they have never witnessed or have knowledge of physical abuse happening in facility. The administrator confirmed that no resident or resident responsible parties have issued any concerns of abuse to them.
Interviews also revealed that three of four staff stated they did not witness any neglect with residents in care, while one of four staff members stated that the facility was short staffed at one point stating that this could be example of neglect.
CONTINUED ON 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Jenifer Tirre	TELEPHONE: (714) 401-6844
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023

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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Control Number 22-AS-20200914090403

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: MERRILL GARDENS AT HUNTINGTON BEACH	FACILITY NUMBER: 306005275
	VISIT DATE: 12/19/2023

NARRATIVE

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The Facility Administrator confirmed that during the time of the initial complaint several staff members left or were let go due to unsatisfactory job performance and attendance issues. During Time of COVID Pandemic, facility used staffing agency to help fill shifts. Of the staff members mentioned in the complaint, two of six resigned while four members were terminated due to write ups for excessive breaks, tardiness, and attendance issues. Staff members mentioned in the complaint have no longer been working at the facility as of September 13, 2023.

Interviews conducted with residents revealed that seven of seven residents interviewed stated they had no concerns with the staff at the facility and that facility provides good care to residents. Residents interviewed state they have not witnessed any kind of neglect or abuse. Long Term Care Ombudsman interview also revealed they had no concerns about the residents in care.

Interviews revealed that Administrator was unaware of issues of abuse on residents in facility. Three of four staff members confirmed that Administrator was knowledgeable of issues with staff in facility and stated that Administrator would try to resolve issues that occurred. In relation to staff members mentioned in complaint, Administrator maintained Documented Discussions violating facility policies which Administrator addressed staff compliance issues and had staff sign that they participated in discussion.

Based on observations made from interviews conducted and records reviewed, LPA is unable to corroborate allegations made that Facility staff are physically abusing residents, facility staff neglected resident and Administrator failed to address reports of abuse therefore 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 above allegations are deemed UNSUBSTANTIATED.

An exit interview was conducted with Administrator Jill Johnson, and a copy of this report was provided during this visit.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Jenifer Tirre	TELEPHONE: (714) 401-6844
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023

LIC9099 (FAS) - (06/04)

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