374603371-11-23-2022-08-AS-SJAB-CLP22D-20221130160034

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603371
Report Date: 11/23/2022
Date Signed: 11/23/2022 12:37:37 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/02/2021 and conducted by Evaluator Debbie Correia

COMPLAINT CONTROL NUMBER: 08-AS-20210202105737

FACILITY NAME:	MERRILL GARDENS AT OCEANSIDE		FACILITY NUMBER:	374603371
ADMINISTRATOR:	PEREZ, MARIANO		FACILITY TYPE:	740
ADDRESS:	3500 LAKE BLVD		TELEPHONE:	(760) 414-9411
CITY:	OCEANSIDE	STATE: CA	ZIP CODE:	92056
CAPACITY:	0	CENSUS: 0	DATE:	11/23/2022
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Closed Facility - Report sent via USPS Certified Mail		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Facility illegally evicted resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Debbie Correia sent this report to the Licensee's last known mailing address, via USPS certified mail, to deliver the investigation findings for the above listed allegation. The facility was closed on September 24, 2021.

The Department’s investigation consisted of staff and outside source interviews, and a facility and resident records review.

It was alleged facility staff conducted an illegal eviction. An outside source (OS1) interview revealed Resident1 (R1) was in their late 40's, suffered from Lupus and required Assisted Living. The interview with OS1 and a records reveiew also revealed R1 signed an admission agreement with the facility on January 20, 2021 and secured a room with a deposit to reside at the facility.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie Correia	TELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:	DATE: 11/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/23/2022

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 08-AS-20210202105737

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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 OCEANSIDE	FACILITY NUMBER: 374603371
	VISIT DATE: 11/23/2022

NARRATIVE

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OS1 stated R1 had discharged from another facility and was in route to Merrill Gardens. However, while in route R1‘s Responsible Party (RP) was notified R1 was not able to reside at the facility due to their age. An interview with the Executive Director (ED) revealed they received a call from corporate level staff who review all the new admits assessments and intake paperwork. During the call the ED was informed of facility policy that does not allow the admission of individuals under the age of 59. The interview with the ED also revealed they were a new employee and was not aware of the facility's age limitation policy, the ED expressed being very remorseful and apologetic in regard to the situation.

A record review and an interview with OS1 revealed R1 had not yet moved into the facility, and an eviction notice was never issued or warranted because R1 was not yet physically residing at the facility.

Based on LPA’s records review, and interviews conducted with staff and outside sources the above allegation was determined to be unsubstantiated. An unsubstantiated finding means although the allegation may have occurred the preponderance of the evidence standard has not been met.

Due to the facility’s closure, no exit interview was conducted. A copy of this report, along with Licensee Rights (LIC 9058 01/16), were mailed via USPS certified mail to the last mailing address on file.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie Correia	TELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:	DATE: 11/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/23/2022

LIC9099 (FAS) - (06/04)

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