435202806-10-29-2024-26-AS-KHOS-DBCPUF-20241125103728

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202806
Report Date: 10/29/2024
Date Signed: 10/29/2024 02:37:55 PM

Unsubstantiated

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
08/16/2023 and conducted by Evaluator Christine Dolores

COMPLAINT CONTROL NUMBER: 26-AS-20230816163108

FACILITY NAME:	MERRILL GARDENS AT GILROY		FACILITY NUMBER:	435202806
ADMINISTRATOR:	NELSON RODRIGUES		FACILITY TYPE:	740
ADDRESS:	7610 ISABELLA WAY		TELEPHONE:	(206) 676-5300
CITY:	GILROY	STATE: CA	ZIP CODE:	95020
CAPACITY:	214	CENSUS: 142	DATE:	10/29/2024
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Billy Mitchell		TIME COMPLETED:	02:40 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility does not have sufficient staffing in memory care to meet the needs of residents

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Christine Dolores arrived to the facility unannounced to deliver the finding of the above allegation. LPA met with General Manager Billy Mitchell.

On 08/16/2023, the Department received the complaint. On 08/22/2023, the initial complaint investigation was conducted. The following documents were obtained to include staff schedule, caregiver job description, resident roster, and 4 resident’s files.

It’s alleged that the facility does not have sufficient staffing in memory care (aka Garden House) to meet the needs of the residents, as it’s alleged that there is an average of 2 caregivers daily for all of the residents in memory care. It was alleged that the caregivers are also required to do housekeeping chores to include dishwashing, which does not allow the staff time to provide care to the residents. PAGE 1 OF 3.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Christine Dolores	TELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2024

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 3

Control Number 26-AS-20230816163108

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: 10/29/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

On 08/22/2023, 1 witness was interviewed. Based on witness (W1) interview, it was stated that the facility is short staffed mostly everyday. It was stated that the morning and afternoon shift has 2 caregivers and 1 medtech. W1 states that on 08/22/2023, there was only 2 staff. W1 states that he/she is constantly looking for staff to help R1. W1 states if he/she is really complaining the staff come within 10-15 minutes. W1 stated that on 08/22/2023, staff came after 45 minutes and apologized for not coming sooner as the staff needed to take a lunch. W1 states it doesn’t happen often.

On 08/22/2023, 8 staff members were interviewed. Based on staff interview, 7 out of 8 staff stated the facility’s memory care has sufficient staff to meet the needs of the residents. It was stated that there are 4 staff (3 caregivers and 1 medtech) in the morning shift, 3 staff (2 caregivers and 1 medtech) in the evening shift, and 2 staff for the overnight shift. It was stated that the staff used to wash dishes around December 2022 time, however, since August 2023 the kitchen staff does all of the dishes. It was stated that the staff are assigned to groups, and they help each other out as a team. It was stated that the medtech also assist with care giving duties, when needed. 1 out of 8 staff stated they need more staff in memory care.

On 08/22/2023, LPA Dolores entered the memory care unit around 11:50am and observed 2 staff were working in memory care, 1 caregiver and 1 medtech/caregiver. Based on interview with staff, the third caregiver was on break and the fourth caregiver was somewhere in the building but could not be located at that moment. LPA Dolores observed 3 housekeeping staff. After a few minutes, LPA observed the third caregiver walking down the hallway. LPA interviewed the fourth caregiver who states to be late to work. LPA Dolores observed lunch started at 12:10PM and observed 2 staff assisting the residents with dining. Based on record review, there were 30 residents residing in memory care.

PAGE 2 OF 3.

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Christine Dolores	TELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 26-AS-20230816163108

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: 10/29/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Based on record review of the facility’s staffing schedule, in July 2023 the AM and PM shift had 3 caregivers and 1 Medtech scheduled and 2 staff for NOC shift. There was only 1 day of the month (Saturday 07/22/2023) where there was only 2 caregivers and 1 Medtech scheduled in the PM.

In August 2023 the AM shift had 3 caregivers and 1 Medtech, PM shift had 2 caregivers and 1 Medtech, and NOC shift had 2 staff scheduled. On 08/22/2023, the schedule shows 3 caregivers and 1 Medtech in the AM and 2 caregivers and 1 Medtech in the PM.

The Department has investigated the above allegation. Based on interview, record review and observation the above allegation is unsubstantiated. An unsubstantiated finding indicated that although the allegation is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with General Manager, Billy Mitchell and a copy of the report was provided.

PAGE 3 OF 3.

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Christine Dolores	TELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 3