425850140-5-7-2025-29-AS-KBUY-DH4T9Q-20250528143218

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425850140
Report Date: 05/07/2025
Date Signed: 05/07/2025 03:23:43 PM

Unsubstantiated

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
05/06/2025 and conducted by Evaluator Melisa Rankin

COMPLAINT CONTROL NUMBER: 29-AS-20250506094736

FACILITY NAME:	MERRILL GARDENS AT SANTA MARIA		FACILITY NUMBER:	425850140
ADMINISTRATOR:	MICHAEL EASBEY		FACILITY TYPE:	740
ADDRESS:	1220 SUEY ROAD		TELEPHONE:	(805) 928-2662
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93454
CAPACITY:	330	CENSUS: 190	DATE:	05/07/2025
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Michael Easbey		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Facility did not meet resident's needs
Facility did not seek timely medical attention for resident

INVESTIGATION FINDINGS:

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On 05/07/2025 at 10:30 a.m. Licensing Program Analyst (LPA) Rankin conducted a 10-day complaint visit to the facility above. LPA met with Michael Easbey, Administrator and explained the purpose of the visit.

During the investigation, LPA Rankin observed the facility, toured Resident 1’s (R1) room, collected relevant documentation, interviewed administrator, staff, residents, and spoke with a responsible party for R1.

On the allegations: Facility did not meet resident's needs and facility did not seek timely medical attention for resident.
It was alleged on 05/01/2025 the facility failed to provide checks to R1. Allegations stated that R1 was found in their room lying in bodily fluid, they were unresponsive to questions, and that there was discharge coming from residents’ eyes. It was stated the concerns were that staff was unaware of when R1 was last checked and that R1 was laying in their bed in the condition noted above for many hours without staff check ins.
Continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025

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 3

Control Number 29-AS-20250506094736

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: 05/07/2025

NARRATIVE

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LPA Rankin arrived at the facility, and at approximately 10:40 a.m. interviewed the Administrator. Administrator explained the facility has a non-licensed Independent Housing part of the campus and a licensed part that has a Memory Care unit, and two (2) 3-story buildings that house residents who are noted in their chart as Assisted Living and “Assisted Living No Care”. The level of care is based on assessments/evaluations conducted to establish what Adult Daily Living (ADL) care and support is needed.

At approximately 10:55 a.m. LPA toured R1’s room. Evidence of bodily fluid was noted on the mattress, there was no smell observed, and the stain was in one central location of the mattress, no other concerns noted in the room.

Documentation reviewed at approximately 11:15 a.m. for R1 noted on various documents such as the LIC 602A Physician’s Report, dated 04/11/2024 that the resident is independent, can manage their own medication, has no cognitive concerns, and is able to manage all ADL’s. The “Capability Evaluations” report dated 11/19/2024, in which the facility evaluates the resident for additional services needed, and the Invoice for R1 for April and May of 2025 show the rates and charges are based on “Assisted Living No Care”. There are no additional charges itemized or noted on either documents.

LPA interviewed Staff 1, 2, and 3 (S1, S2, S3). All staff explained to the LPA the check in process for “Assisted Living No Care” residents. All staff stated that check-in for the “Assisted Living No Care” residents are done between 6:00 a.m. to 9:00 a.m. daily. Residents are able to check-in via an electronic button between those hours. A list is provided to caregivers by approximately 9:05 a.m. who then call or go to each resident and initial the list when a resident contact was made. Documents collected show that R1 was noted as in the dining room on 4/29/2025 and 4/30/2025. S2 initialed both days. S2 was the caregiver that responded to the initial check on 05/01/2025. S2 stated family called to say they couldn’t get a hold of R1. S2 confirmed that R1 was found in the condition noted above, with the exception of S2 did not notice eye discharge. S2 stated that R1 is a “Assisted Living No Care” resident, therefore checks are done daily during check in hours. S2 stated R1 is very independent, consistent in their schedule, and is observed daily going through their routine.

Continued on 9099-C

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 29-AS-20250506094736

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: 05/07/2025

NARRATIVE

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Interview with Family 1 (F1) at 12:19 p.m. was conducted by LPA. F1 stated R1 had a massive stroke. F1 stated the facility has provided excellent care and does not have any concerns of the care provided to R1. F1 stated R1 is able to communicate since the incident and stated that the day prior to the incident, was normal for R1, that R1 had gone to dinner, returned to their room, and went to bed as normal. F1 stated R1 is independent. F1 stated another family member was scheduled to talk with R1 at 7:30 a.m. the morning of 05/01/2025 and when R1 did not call, and did not respond to calls, family member contacted the facility to provide a check on R1. That is when R1 was discovered by caregiver. F1 stated they have no concerns of R1’s care by facility. Per F1, R1 has a history of eye issues, and that R1 did have discharge when they had the stroke.
At approximately 1:37 p.m. LPA began interviewing residents. All residents interviewed have no concerns about their care at the facility. Both explained they are independent and use the check in button process daily and that if they fail to check in that facility staff come to find them within the hour following 9:00 a.m.

Based on interviews, observation and documentation, there is not sufficient evidence, at this time, to prove the alleged violations did occur therefore the allegations are unsubstantiated.

Exit interview conducted, copy of report given.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025

LIC9099 (FAS) - (06/04)

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