361880525-1-13-2025-56-AS-EMAN-DDBP5E-20250127100036

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880525
Report Date: 01/13/2025
Date Signed: 01/13/2025 11:54:58 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/08/2025 and conducted by Evaluator Paola Guerrero

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20250108152702

FACILITY NAME:	MERRILL GARDENS AT RANCHO CUCAMONGA		FACILITY NUMBER:	361880525
ADMINISTRATOR:	USMAN CHAUDARY		FACILITY TYPE:	740
ADDRESS:	9942 HIGHLAND AVENUE		TELEPHONE:	(909) 303-9545
CITY:	RANCHO CUCAMONGA	STATE: CA	ZIP CODE:	91737
CAPACITY:	150	CENSUS: 102	DATE:	01/13/2025
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Usman Chaudary- Administrator		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Facility is unable to provide power during a power outage to residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Facility Administrator Usman Chaudhary and explained the purpose of the visit. The investigation consisted of interviews, observations, and review of records.

First allegation: Facility is unable to provide power during a power outage to residents. Regarding the allegation LPA conducted an interview with Facility Administrator regarding the allegation. Facility Administrator informed LPA that on 1/7/2025 their facility experienced a Public Safety Power shutoff (PSPS), by Southern California Edison (SCE), due to extreme weather (wind) conditions. During the interview Facility Administrator informed LPA that on 1/7/2025 facility utilized portable power generators, portable lighting, and provided portable oxygen tanks to residents in need. On 1/13/2025 LPA observed that the facility currently had power. Furthermore, on 1/13/2024 LPA was accompanied by Facility Administrator on a walkthrough of the facility for the purpose to ensure that the facility was meeting resident needs during Public Safety Power Shutoffs.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Paola Guerrero	TELEPHONE: (951) 473-7024
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2025

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 56-AS-20250108152702

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: MERRILL GARDENS AT RANCHO CUCAMONGA	FACILITY NUMBER: 361880525
	VISIT DATE: 01/13/2025

NARRATIVE

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During the walkthrough LPA observed portable power generators to be stored along with portable light stands, and flashlights. During the walkthrough LPA inspected facility food supply and observed sufficient food supply to be stored. LPA conducted interviews with residents and four out of four residents informed LPA that facility informed residents regarding the power shutoff four out of four residents informed LPA feeling safe during the shutoff and stated that the facility met their care needs during the time of the Public Safety Power Shutoff (PSPS). Based on corroborating evidence obtained during the course of the investigation, LPA has determined that the above allegation is Unsubstantiated.

Unsubstantiated: meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted where this report (LIC 9099) was discussed, and a copy was provided to Facility Administrator Usman Chaudhary at the end of the visit.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Paola Guerrero	TELEPHONE: (951) 473-7024
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2025

LIC9099 (FAS) - (06/04)

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