435202806-12-6-2024-26-AS-KHOS-DC2QS8-20241217112506

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202806
Report Date: 12/06/2024
Date Signed: 12/06/2024 11:57:40 AM

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
12/08/2023 and conducted by Evaluator Christine Dolores

COMPLAINT CONTROL NUMBER: 26-AS-20231208112008

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: 156	DATE:	12/06/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Jocelyne Bailon		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Facility did not seek medical care for multiple residents who were exhibiting symptoms of scabies
Facility did not communicate with residents physicians for a change of condition
Facility did not quarantine residents who were exhibiting symptoms of scabies
Facility is not discarding PPE gowns after assisting residents with a contagious disease

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to deliver the findings of the above allegations. LPA met with Health Services Director, Jocelyne Bailon.

On 12/08/2023, the Department received the complaint. On 12/15/2023, the initial complaint investigation was conducted. The following documents were obtained to include resident roster, 5 residents physician's report, appraisal/needs and services plan, progress notes, and third-party communication notes.

It was alleged that 5 residents (R1 – R5) were showing symptoms of scabies and the facility did not seek medical care and communicate with the resident’s physicians for multiple residents who were exhibiting symptoms. Page 1 of 3.

Unfounded

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: 12/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2024

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-20231208112008

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: 12/06/2024

NARRATIVE

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On 12/15/2023, 6 staff members were interviewed. Based on staff interview, there were a couple residents who were diagnosed with scabies on separate occasions (10/26/2023 and 11/06/2023), but as of 12/15/2023 the residents no longer had scabies. It was stated that some residents did not have a confirmed diagnosis of scabies and were experiencing symptoms of itchiness. These residents’ physicians were notified and prescribed a PRN medication.

The review of records show that R1 was noted to have itchiness and redness on 10/26/2023. Based on staff interview, R1 was diagnosed with scabies. R1’s hospice nurse was notified and R1 was prescribed and applied a PRN medication.

Staff noted R2 was experiencing symptoms of itchiness. R2’s doctor and authorized representative was notified, and R2 was prescribed a PRN medication. R2 was also being seen by a home health agency for another condition.

Staff stated that R3’s itching was caused by dry skin. R3’s doctor was informed and prescribed a PRN medication. Staff denied the observation of R3’s skin being red and bumpy.

R4 was noted to be under hospice care. Staff stated that R4 was not exhibiting any symptoms. The review of R4’s records did not include notes of a diagnosis of scabies or symptoms of itchiness.

Staff stated that R5 was being seen by a home health agency and was not experiencing any symptoms of scabies. The review of R5’s records did not include notes of a diagnosis of scabies or symptoms of itchiness.

It was alleged that staff are not discarding PPE gowns after assisting residents who are under isolation or quarantine because they were not told to discard it. It was also alleged that residents who were experiencing symptoms of scabies were not placed under quarantine. 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: 12/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 26-AS-20231208112008

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: 12/06/2024

NARRATIVE

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On 12/15/2023, 6 staff members were interviewed. Based on staff interview, 6 out of 6 staff members stated they discarded the PPE gowns after every use. Based on review of the facility’s infection control plan, it’s stated that items and equipment that are single-use shall be disposed of in an appropriate waste container with a tight-fitting cover.

Based on staff interview, the gowns being used are disposable and they are disposed in the trash bin upon exiting the resident rooms, which is located next to the isolation room.

Staff stated that resident’s who were suspected to have scabies and were experiencing symptoms of scabies were placed under isolation until they were informed of a diagnosis from the resident’s physicians. Those who were experiencing itchy skin due to a condition not related to scabies (example dry skin), were not placed under quarantine. Based on review of the facility’s infection control plan, it’s stated there shall be separation and care of residents whose illness requires separation, including quarantine or isolation, from others.

The Department has investigated the above allegations. Based on interview, record review and observation the above allegations are unfounded, meaning the allegations are 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 and a copy of the report was provided.
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SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Christine Dolores	TELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2024

LIC9099 (FAS) - (06/04)

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