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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 425850140
Report Date: 01/25/2024
Date Signed: 01/25/2024 04:04:32 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/18/2024 and conducted by Evaluator Erika Miller
COMPLAINT CONTROL NUMBER: 29-AS-20240118165915
FACILITY NAME:MERRILL GARDENS AT SANTA MARIAFACILITY NUMBER:
425850140
ADMINISTRATOR:SHERBERG, AUDIEFACILITY TYPE:
740
ADDRESS:1220 SUEY ROADTELEPHONE:
(206) 676-5300
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY:330CENSUS: 234DATE:
01/25/2024
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Audie Sherberg, AdministratorTIME COMPLETED:
04:14 PM
ALLEGATION(S):
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Facility is in disrepair.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Erika Miler and Jenny Olson conducted an unannounced 10-day complaint visit and to issue final findings on the allegation above. During the investigation, LPAs toured the facility and interviewed Administrator, staff, and residents on January 25, 2024 from 10:30 am to 2:00 pm. LPAs also obtained and reviewed relevant documents. LPAs met with Audie Sherberg and explained the purpose of the visit.

On the allegation: Facility is in Disrepair
Reporting party (RP) advised that the handicap door entry button in building 1350, has not been working for about six to eight weeks. A sign was left on the door that states the door will be repaired "tomorrow". RP stated that maintenance has been contacted and has advised that a part is on order. The door is almost impossible for some people on walkers or in mobile wheelchairs to open and enter the door without assistance from others. In addition, there is water leaking for the top of the door frame, so facility added a sign and a caution cone, that made it more difficult to navigate.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Erika Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2024
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 2
Control Number 29-AS-20240118165915
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: MERRILL GARDENS AT SANTA MARIA
FACILITY NUMBER: 425850140
VISIT DATE: 01/25/2024
NARRATIVE
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On January 25, 2024, LPAs interviewed six residents, three of the six stated that they could not open the door without assistance. A resident indicated that the 1350 handicap button was not working and took more than 3 weeks to resolve this issue. Resident advised that they could enter through the dinning room door, but when locked had to walk around the entire building to gain access. Another resident advised that the dryer on the second floor in Building 1220 has been broken since December 15, 2023 and remains out of service. LPAs observed a sign on the dryer that advised as such. A new dryer was delivered and ready to be installed. In addition, LPAs also observed a sign on the back gate near the pool patio, that stated, gate lock does not operate from outside. LPAs interviewed maintenance director, who provided work orders that reflected a timeline of incidents and actions taken. Maintenance director also advised that water leakage from an air conditioning unit above an entry door is currently being repaired and repairman was on site January 25, 2024. Interviews and record review revealed that facility attempted to resolve all issues in a timely manner. Based on the information obtained, the allegation is deemed substantiated at this time. A Technical Violation was issued as the facility attempted to mitigate the disrepair timely.


Exit interview, report given, and appeal rights.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Erika Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2