306005275-2-14-2024-22-AS-MSTC-D2W4EW-20240228180258

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005275
Report Date: 02/14/2024
Date Signed: 02/14/2024 02:17:26 PM

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
02/06/2024 and conducted by Evaluator Jessica Cho

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20240206112257

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: 118	DATE:	02/14/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Jill Johnson-General Manager		TIME COMPLETED:	02:35 PM

ALLEGATION(S):

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Facility is not following universal precautions/infection control with residents, staff, and visitors.
Facility did not notify residents and responsible parties of scabies outbreak.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jessica Cho made an unannounced complaint visit for the purpose to investigate into the above allegations. LPA met with General Manager (GM) Jill Johnson and Memory Care Director (MCD) Patty Wanjohi and explained the reason for the visit. During the course of the investigation, LPA interviewed staff and obtained copies of pertinent facility/resident records such as the roster, scabies policy and procedures, and all resident face sheets, physician's reports, Medication Administration Record (MAR) forms, and progress notes. The investigation revealed the following:

It is alleged that the faciliy is not following the universal precautions/infection control with residents, staff, and visitors. LPA visited two resident rooms and observed that the clean laundry were sealed in a large, black bag and secured in the residents' closets. Based on the review of the scabies policy and procedures, facility is adhering with the guidelines for (14) consecutive days to prevent the spread of scabies.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lourdes Montoya	TELEPHONE: (714) -70-2870
LICENSING EVALUATOR NAME: Jessica Cho	TELEPHONE: 714-703-2853
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2024

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-20240206112257

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: 02/14/2024

NARRATIVE

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Interviews conducted with three out of the three staff confirmed that the residents immediately began their treatment, all residents' units including the bathrooms are cleaned/disinfected daily including their clothing items and linens, residents are receiving showers daily, and the common areas are vacuumed and disinfected daily as required per policy.

It is alleged that the facility did not notify the residents and responsible parties of the scabies outbreak. LPA reviewed all residents' progress notes which indicated that the families were verbally informed of the scabies outbreak and facility requested consent to administer the scabies medication.

Therefore, based on the observations made, interviews which were conducted, and the records that were reviewed, 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 following allegations: Facility is not following universal precautions/infection control with residents, staff, and visitors and Facility did not notify residents and responsible parties of scabies outbreak are deemed UNSUBSTANTIATED.

An exit interview was conducted with General Manager Jill Johnson, and a copy of this report was provided at the end of the visit.

SUPERVISOR'S NAME: Lourdes Montoya	TELEPHONE: (714) -70-2870
LICENSING EVALUATOR NAME: Jessica Cho	TELEPHONE: 714-703-2853
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2024

LIC9099 (FAS) - (06/04)

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