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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202806
Report Date: 06/06/2025
Date Signed: 06/06/2025 12:06:53 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/03/2025 and conducted by Evaluator Christine Kabariti
COMPLAINT CONTROL NUMBER: 26-AS-20250603161256
FACILITY NAME:MERRILL GARDENS AT GILROYFACILITY NUMBER:
435202806
ADMINISTRATOR:BILLY MITCHELLFACILITY TYPE:
740
ADDRESS:7610 ISABELLA WAYTELEPHONE:
(206) 676-5300
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY:214CENSUS: 144DATE:
06/06/2025
UNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Jocelyne Bailon SalocheTIME COMPLETED:
12:10 PM
ALLEGATION(S):
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Staff did not give resident medication as prescribed
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christine Kabariti arrived unannounced to open the initial complaint investigation. LPA met with Health Services Director (HSD) Jocelyne Bailon Saloche.

On 06/03/2025, the Department received a complaint alleging that the facility staff are not giving resident (R1) medication as prescribed. On 06/06/2025, the initial complaint investigation was conducted.

The following documents were obtained to include resident (R1)'s physicians report, appraisal/needs and services plan, eMAR summary for April and May 2025, medical records, current medication list, and email correspondences. Page 1 of 2.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Christine Kabariti
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2025
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 2
Control Number 26-AS-20250603161256
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME: MERRILL GARDENS AT GILROY
FACILITY NUMBER: 435202806
VISIT DATE: 06/06/2025
NARRATIVE
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On 04/04/2025, the facility was provided R1’s hospital discharge summary which listed multiple changes to R1’s medication regimen. On 05/31/2025, a staff from the facility called R1’s responsible party asking if he/she was okay with the change to R1’s medication (M1) as stated on the updated LIC602. Upon reaching out to R1’s primary care physician (PCP), it was discovered that no changes were made since 04/03/2025.

During the investigation, it was found that a staff (S2) had called R1’s responsible party to inform him/her about a change in R1’s medication (M1) per a new physician’s report that was received on 05/30/2025.

Based on interview with S2, S2 admitted to misspeaking about the medication change during the call with R1’s responsible party. It was stated that S2 was confused about R1’s PM (M1) medication order because S2 only works AM shifts and was not familiar with R1’s PM medication regimen. Upon further reviewing R1’s medications, S2 then realized that R1 did not have a change in medication order.

S2 states that R1 continued to receive his/her medication as normal and no changes to his/her medication regimen was actually made.

Based on interview with staff (S1), S1 corroborated S2’s statement.

The review of records shows that R1’s medication (M1) order did not change and R1 continued to receive his/her medication as prescribed by the physician.

The Department has investigated the above allegation. Based on interview, record review and observation the above allegation is unfounded, meaning the allegation is false, could not have happened, and/or is without a reasonable basis. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Health Services Director, Jocelyne Bailon Saloche and a copy of the report was provided.

Page 2 of 2.
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Christine Kabariti
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2