374603371-11-23-2020-08-AS-DPOL-BXS3M3-20210130172139

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603371
Report Date: 10/27/2020
Date Signed: 11/23/2020 01:57:58 PM

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
02/05/2020 and conducted by Evaluator Jonathan C Pineda

COMPLAINT CONTROL NUMBER: 08-AS-20200205103546

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:	175	CENSUS: 143	DATE:	10/27/2020
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Mariano Perez, Administrator		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

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Facility staff engaged in verbal altercation in the presence of residents and failed to provide a comfortable environment for residents in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jonathan Pineda conducted an unannounced complaint tele-visit to deliver findings on the above allegation. LPA identified himself and stated the purpose of the call. LPA spoke with Mariano Perez, Administrator.

The Department’s investigation included observations, a tour of the facility, a review of records, interviews with resident, staff, and outside sources.

It was alleged that facility staff engaged in verbal altercation in the presence of residents and failed to provide a comfortable environment for residents in care. Staff interview revealed that S2 (See confidential names list) was performing a safety in the dining room after breakfast around 10:00 am on 2/5/20. Investigation revealed there were no residents in the dining room at this time. S2 advised that during their safety check, a container of cleaning chemicals was observed unattended. S2 advised that in a firm tone, they instructed S1 to secure the chemicals.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR NAME: Jonathan C Pineda	TELEPHONE: (619) 481-0846
LICENSING EVALUATOR SIGNATURE:	DATE: 11/23/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/23/2020

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-20200205103546

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: 10/27/2020

NARRATIVE

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S2 returned approximately an hour later and observed the chemicals still unsecured. S2 advised that he grabbed the chemicals and started to walk away when S1 yelled, “You can’t take those! Are you dumb?”. S2 advised that S1 proceeded to throw a wet sponge at them. Investigation and interviews conducted did not identify any residents as possible witnesses. Staff interviews revealed they have never observed S2 yell at their staff in front of residents. S4 advised that they have observed S2 reprimand his staff as they were walking by the kitchen, however it was never in the presence of residents. S4 advised that they have never observed S2 behave or speak inappropriately to any staff member. Investigation and interviews conducted did not identify any residents as possible witnesses.

The Department investigated the allegation that facility staff engaged in verbal altercation in the presence of residents and failed to provide a comfortable environment for residents in care. Based on observations and interviews, it is determined that the allegation is UNSUBSTANTIATED. There is not a preponderance of the evidence to prove the allegation occurred.

An exit interview was conducted via telephone and a copy of this report along with Licensee/Appeal Rights (LIC9058 01/16) was provided to Mariano Perez via email. An electronic email read receipt confirms the documents were received.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR NAME: Jonathan C Pineda	TELEPHONE: (619) 481-0846
LICENSING EVALUATOR SIGNATURE:	DATE: 11/23/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/23/2020

LIC9099 (FAS) - (06/04)

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