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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603274
Report Date: 08/19/2021
Date Signed: 08/19/2021 01:17:24 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:MERRILL GARDENS AT BANKERS HILLFACILITY NUMBER:
374603274
ADMINISTRATOR:LORI HANSENFACILITY TYPE:
740
ADDRESS:2567 2ND AVETELEPHONE:
(619) 209-5216
CITY:SAN DIEGOSTATE: CAZIP CODE:
92103
CAPACITY:100CENSUS: 84DATE:
08/19/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:General Manager Lori Hansen & Resident Care Director Kelly BiondoTIME COMPLETED:
11:45 AM
NARRATIVE
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Licensing Program Analyst (LPA) Rebecca Ruiz, County of San Diego Nurse Contractors, Elizar Perez and Sandra Braxton with the HAI Program, conducted an on-site HAI assessment visit. LPA and team identified themselves and discussed the purpose of the visit with General Manager Lori Hansen and Resident Care Director Kelly Biondo.

The Department conducted an on-site visit to provide technical assistance and to evaluate the facility's mitigation plan to include disinfection, testing, vaccination, and screening protocols as well as the use of personal protective equipment (PPE). During today's visit, the team interviewed the General Manager and Resident Care Director and the team conducted a walk-though of the facility. A debriefing was conducted with General Manager Lori Hansen and Resident Care Director Kelly Biondo at the conclusion of the visit.

During today's visit, no deficiencies were cited. An exit interview was conducted with the General Manager and Resident Care Director and a copy of this report, along with Licensee Rights (LIC 9058 01/16), were provided to Lori Hansen via electronic mail. An electronic receipt of confirmation was requested to be sent by Lori Hansen upon receipt of the documents.
SUPERVISOR'S NAME: Alexandre VoTELEPHONE: (619) 385-7506
LICENSING EVALUATOR NAME: Rebecca A RuizTELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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