374604405-2-5-2026-08-AS-SJAB-DR6RYF-20260210122614

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604405
Report Date: 02/05/2026
Date Signed: 02/05/2026 03:29:26 PM

Unsubstantiated

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
01/22/2025 and conducted by Evaluator Amy Rodgers

COMPLAINT CONTROL NUMBER: 08-AS-20250122094452

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: 83	DATE:	02/05/2026
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	General Manager Jill Johnson		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff did not address resident's change in condition

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, was greeted by facility staff, and explained the purpose of the visit to General Manager Jill Johnson

During today’s visit, LPA observed residents in care and obtained copies of facility records and interviewed staff..The Department’s investigation consisted of interviews with staff and outside sources, records review, and observations.

On January 22, 2025, the Department received a complaint alleging that staff did not address a resident’s change in condition. More specifically, it was alleged that Executive Director (ED) Lori Hansen interfered with staff documentation related to Resident #1(R1) change of condition. It was reported that the R1dementia is progressing and requires a higher level of care. (Continued on LIC9099-C).

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: 02/05/2026

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-20250122094452

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: 02/05/2026

NARRATIVE

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(continued from LIC 9099)

Review R1's Physician’s Report dated November 11, 2024, revealed diagnoses of Mild Cognitive Impairment (MCI) and Major Depressive Disorder (MDD), along with a history of traumatic subdural hemorrhage. The Physician’s Report does not include a dementia diagnosis.

Review of R1's Care Service Plan assessed on June 1, 2025, and effective June 22, 2025, revealed the resident is non-ambulatory, requiring two-person assist for transfers, frequent hands-on assistance with toileting and dressing, total assistance with showers, drainage bag management four times daily, and medication management. The plan also notes high fall risk and behavioral refusals of care.

Interviews with staff revealed they did not confirm being instructed by S1 to omit or delay documentation related to changes of condition. However, an interview with an outside source revealed S1 accompanied R1 and two outside sources to R1's physician appointment. The outside source reported that during this visit, S1 had a private discussion with the attending physician outside the room. The outside source could not confirm the content of that discussion.

The Department has investigated the above-mentioned allegation and based on interviews and records review, a preponderance of evidence does not exist to prove that the alleged violation occurred; therefore, this allegation is deemed UNSUBSTANTIATED.

An exit interview was conducted with General Manager Jill Johnson, whose signature below confirms receipt of a copy of this report, LIC811 Confidential Names list, and the Licensee Appeal Rights (LIC9058 03/22).

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: 02/05/2026

LIC9099 (FAS) - (06/04)

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