374604405-5-21-2024-08-AS-LTEZ-CW5TFT-20230929144205

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604405
Report Date: 09/26/2023
Date Signed: 05/21/2024 01:19:02 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 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
08/28/2023 and conducted by Evaluator Nacole Patterson

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20230828151755

FACILITY NAME:	MERRILL GARDENS AT BANKERS HILL		FACILITY NUMBER:	374604405
ADMINISTRATOR:	HANSEN, LORI		FACILITY TYPE:	740
ADDRESS:	2567 2ND AVENUE		TELEPHONE:	(619) 209-5216
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92103
CAPACITY:	100	CENSUS: 92	DATE:	09/26/2023
		UNANNOUNCED	TIME BEGAN:	02:20 PM
MET WITH:	Lori Hansen, Senior General Manager		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Licensee did not charge agreed upon admissions fee.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced visit to deliver findings regarding the above complaint allegation. LPA introduced herself and disclosed the purpose of the visit to Lori Hansen, Senior General Manager.

On 8/28/23 it was alleged that the Licensee did not charge a resident (R1) the agreed upon admissions fee. The Department’s investigation consisted of two unannounced facility visits, review of facility records, interviews with facility staff and outside sources. Staff interview revealed that R1 and their responsible party were given the costs of residency upfront and signed in agreement to the costs via the Residency and Services Agreement. Review of the signed Residency and Services Agreement, itemized billing invoice, and documented communication between the family and Licensee confirmed that the amount charged was the amount that was agreed upon by the Licensee and family. (Continued on LIC9099-C)

This is an amended report from the facility visit conducted on 09/26/2023.

Unfounded

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Jennifer Lott	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Nacole Patterson	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

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-20230828151755

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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 HILL	FACILITY NUMBER: 374604405
	VISIT DATE: 09/26/2023

NARRATIVE

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Based on records and interviews, the allegation that "Licensee did not charge agreed upon admissions fee" is UNFOUNDED, meaning it was false, could not have happened, and/or is without a reasonable basis. The allegation has therefore been dismissed. An exit interview was conducted with Lori Hansen, Senior General Manager, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISOR'S NAME: Jennifer Lott	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Nacole Patterson	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

LIC9099 (FAS) - (06/04)

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