435202806-9-25-2025-26-AS-CKAI-DLUVY2-20250925165026

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 435202806
Report Date: 09/25/2025
Date Signed: 09/25/2025 04:50:33 PM

Document Has Been Signed on 09/25/2025 04:50 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

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
ADMINISTRATOR/ DIRECTOR:	BILLY MITCHELL		FACILITY TYPE:	740
ADDRESS:	7610 ISABELLA WAY		TELEPHONE:	(206) 676-5300
CITY:	GILROY	STATE: CA	ZIP CODE:	95020
CAPACITY: 214		CENSUS: 136	DATE:	09/25/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:15 AM
MET WITH:	General Manager, Billy Mitchell		TIME VISIT/ INSPECTION COMPLETED:	05:00 PM

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	Licensing Program Analyst (LPA) Christine Kabariti arrived unannounced to conduct the facility's required - 1 year annual inspection. LPA met with General Manager (GM) Billy Mitchell and Health Services Director (HSD), Jocelyn Bailon Saloche. During visit, LPA toured the facility with the HSD to include the common areas, kitchen, resident bedrooms, bathrooms, and exterior. Facility temperature maintained between 71 to 74 degrees F. All emergency exits were clear of obstruction. Activities calendar and menu posted in a visible area. It was observed that the only elevator in the facility that goes to Plaza (2nd and 3rd floor) had "out of order" signs posted. GM stated the elevators broke down yesterday on 09/24/2025 around 3:00pm. GM stated that they immediately called the vendor and had a technician come to the facility the same day around 4:30pm - 5:00pm. They were informed that the elevator is still functional however, the doors will not automatically close on its own but the elevator can be operated manually. GM states as of today, if any of the residents want to use the elevator, they need to call a staff to assist them in the elevator. GM states all the staff are trained on how to operate the elevator manually. In addition, they residents (who are able) and staff are using the stairwells. LPA observed the stairwells are equipped with evac chairs. GM states that they are offering in-room dining for residents who rather stay in their rooms and activities on the 2nd and 3rd floor of Plaza. GM is actively working with the vendor to fix the elevator. Page 1 of 2.

NAME OF LICENSING PROGRAM MANAGER: Jackie Jin
NAME OF LICENSING PROGRAM ANALYST: Christine Kabariti
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 09/25/2025

NARRATIVE

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Kitchen is supplied with at least 2 days worth of perishables and 7 days worth of non-perishable foods. Items inside the refrigerator observed covered and labeled. Refrigerator temperature maintained at 39 degrees F. Freezer temperature was maintained at 8 degrees F. Staff stated they had the freezer opened which may have affected the temperature. The kitchen staff showed a log of the freezer temperatures which they monitor every morning, and logged below 0 degrees F. Toxins, chemicals and disinfectants are secured and stored separately from the food supply.

A total of 9 resident bedrooms were observed. 9 resident bedrooms are equipped with beds, linens, night stands, dressers, and adequate lighting. Oxygen in use signs posted on the doors of residents who are using oxygen per physician's orders. Between 11:20AM - 12:30PM, the hot water temperature was measured in rooms #125B, 120, 118B, 203, 209, and 306 which measured between 132.6 - 136.4 degrees F. The maintenance personnel stated they had their water boiler serviced recently. During visit, facility had a plumber who was actively working on reducing the hot water temperature. At 4:26PM, the hot water was measured and observed maintained at 115.5 degrees F.

7 resident records were reviewed and observed complete and up-to-date. 5 out of 7 residents were on medication management. The 5 residents centrally stored medications and records were reviewed and all medications were accounted for. 5 staff files were reviewed and observed complete and up-to-date to include a background clearance. The staff are provided annual training on topics to include but not limited to dementia, Alzheimer's, prohibited and restricted health conditions, hospice, pressure sores, medications, caregivers, and blood borne pathogens.

The facility is equipped with smoke and carbon monoxide detectors. Fire extinguishers were last serviced on 4/26/2025. LPA observed the facility first aid kit and it was observed to be complete. The facility fire/earthquake/elopement drill log was reviewed and drills are being conducted quarterly. The last drill was conducted in August and September 2025. Facility has an updated emergency disaster plan and infection control plan. No deficiencies were cited today per California Code of Regulations, Title 22. This report was reviewed with General Manager, Billy Mitchell and a copy of the report was provided.

NAME OF LICENSING PROGRAM MANAGER: Jackie Jin
NAME OF LICENSING PROGRAM ANALYST: Christine Kabariti
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2025

LIC809 (FAS) - (06/04)

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