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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604405
Report Date: 02/13/2026
Date Signed: 02/13/2026 01:25:02 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 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
07/15/2025 and conducted by Evaluator Amy Rodgers
COMPLAINT CONTROL NUMBER: 08-AS-20250715131154
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: 84DATE:
02/13/2026
UNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:General Manager Jill JohnsonTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff did not provide reasonable privacy to resident in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Amy Rodgers conducted an unannounced complaint visit to deliver findings regarding the above-mentioned allegation. LPA identified herself to, was greeted by, and explained the purpose of the visit to General Manager Jill Johnson.

During today’s visit, LPA observed residents in care, interviewed staff and obtained copies of facility records.

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

On June 15, 2025 , the Department received a complaint alleging that staff did not provide reasonable privacy to the resident in care, specifically Resident #1 (R1) Email correspondence dated April 25, 2025 from R1's Responsible person to Senior General Manager(ED) Hansen instructed ED Hansen not to contact the hospital and stated that R1 reposnsible person was the designated representative for updates. (Continued on LIC9099)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 08-AS-20250715131154
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: MERRILL GARDENS AT BANKERS HILL
FACILITY NUMBER: 374604405
VISIT DATE: 02/13/2026
NARRATIVE
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LIC9099-C Continuation Page (Report 1)

Department review of facility records document Release of Client/Resident Medical Information was signed. However, the document includes language that the person who authorized this release may revoke this authorization at any time. Department records review reveal and email correspondence dated April 25, 2025 from R1's responsible person to ED Hansen instructing ED Hansen not to contact the hospital and stated that R1's responsible person was the designated representative for updates.

ED responded in writing:“As long as (R1) is my resident, I am required and mandated by the Dept of Social Services to speak with the hospital to have updates and make progress notes on (R1's) chart at my community. I / or someone designated on our community’s behalf, will be calling every single day [R1} in the hospital and / or in a rehab to get updates and notating."

The Department has investigated the above-mentioned allegation and based on interviews and records review, the preponderance of the evidence has been met, therefore, this allegation is deemed substantiated. The following deficiency is cited per CA Code of Regulations Title 22 and noted on the attached LIC9099-D page.

An exit interview was conducted with General Manager Jill Johnson, whose signature below confirms receipt of a copy of this report, LIC811, and the Licensee Appeal Rights (LIC9058 03/22).
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Citations on this Visit Report are Under Appeal!

Control Number 08-AS-20250715131154
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: MERRILL GARDENS AT BANKERS HILL
FACILITY NUMBER: 374604405
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/13/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type B
03/13/2026
Section Cited
CCR
87468.2(a)(2)
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87468.2(a)(2) To have their records and personal information remain confidential and to approve their release, except as authorized by law.
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The facility shall provide staff training to ensure resident privacy rights are maintained, including honoring the designated representative decision to revoke the authorization at any times.
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This requirement was not met as evidenced by:
Based on interviews and records review, Licensee did not ensure resident privacy rights were maintained. This posed a potential personal rights risk to 1 of 84 residents in care.
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 Proof of policy and training shall be submitted to CCL by the POC date.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 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
07/15/2025 and conducted by Evaluator Amy Rodgers
COMPLAINT CONTROL NUMBER: 08-AS-20250715131154

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: DATE:
02/13/2026
UNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:General Manager Jill JohnsonTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff charged resident for services not provided to the resident
Staff did not report resident's fall to appropriate parties
Staff interfered with resident's toileting care needs
Staff mismanaged resident's medication
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Amy Rodgers conducted an unannounced complaint visit to deliver findings regarding the above-mentioned allegations. LPA identified herself to, was greeted by, and explained the purpose of the visit to General Manager Jill Johnson.

During today’s visit, LPA observed residents in care, interviewed staff and obtained copies of facility records.

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

On July 15, 2025 , the Department received a complaint alleging that above mentioned alligations.
Continued on LIC9099-C page…
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 08-AS-20250715131154
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: MERRILL GARDENS AT BANKERS HILL
FACILITY NUMBER: 374604405
VISIT DATE: 02/13/2026
NARRATIVE
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(continued from LIC9099) page

Department Interviews with staff and review of facility records revealed that an Incident Report dated May 21, 2025 documented a fall, emergency services was called, and notifications were made to the physician and responsible party. Another Incident Report dated July 11, 2025 documented ER transport for hip pain; however, no fall was referenced. Review of the Service Plan dated May 9, 2025 showed toileting assistance was included, and care logs reviewed indicated services were provided as scheduled. Pharmacy fax dated May 10, 2025 and the MAR were reviewed, and no evidence of medication mismanagement was found. Invoices and care logs reviewed confirmed that Level 8 services billed during June and July 2025 were delivered by facility staff.

Department Interviews with staff and outside sources did not reveal any concerns regarding toileting delays, medication errors, or unreported falls beyond what was documented. Documentation reviewed supports that facility staff performed required care tasks and provided billed services.

The Department has investigated the above-mentioned allegations and based on interviews and records review, the preponderance of evidence has not been met; therefore, these allegations are deemed UNSUBSTANTIATED.

An exit interview was conducted with General Manager Jill Johnson, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 03/22).
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5