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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604405
Report Date: 09/29/2022
Date Signed: 09/29/2022 01:26:23 PM


Document Has Been Signed on 09/29/2022 01:26 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108



FACILITY NAME:MERRILL GARDENS AT BANKERS HILLFACILITY NUMBER:
374604405
ADMINISTRATOR:HANSEN, LORIFACILITY TYPE:
740
ADDRESS:2567 2ND AVENUETELEPHONE:
(619) 209-5216
CITY:SAN DIEGOSTATE: CAZIP CODE:
92103
CAPACITY:100CENSUS: 93DATE:
09/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Kelly BiondoTIME COMPLETED:
12:00 PM
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Licensing Program Analysts (LPA) Riza Alvarez and Renita Hall conducted an unannounced Required 1 - Year Visit. The facility file was reviewed prior to the visit. LPA Alvarez and LPA Hall met with Ms. Kelly Biondo, Resident Care Director, and we discussed the purpose of the visit. All staff present have a current criminal record clearance.

LPAs conducted a tour of the facility, both inside and outside, and observed the residents in care. In accordance with the Department’s Infection Control, LPAs evaluated and observed the facility's implementation of its mitigation plan to include disinfection, testing surveillance, and screening protocols as well as the use of personal protective equipment.

No deficiencies were cited or observed on this date.

The Licensee was provided a copy of their appeal rights (LIC9058 03/22). An exit interview was conducted and a copy of this report was given to Ms. Biondo.
SUPERVISOR'S NAME: John RanteTELEPHONE: (619) 767-2330
LICENSING EVALUATOR NAME: Riza Gloria AlvarezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 09/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/29/2022
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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