435202806-4-9-2025-26-AS-KHOS-DFTJNM-20250417071207

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202806
Report Date: 04/09/2025
Date Signed: 04/09/2025 01:34:08 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
05/24/2024 and conducted by Evaluator Christine Kabariti

COMPLAINT CONTROL NUMBER: 26-AS-20240524084602

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: 140	DATE:	04/09/2025
		UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Billy Mitchell		TIME COMPLETED:	01:40 PM

ALLEGATION(S):

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Staff are overcharging residents in care
Staff are falsifying documents
Staff do not keep resident's information confidential

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christine Kabariti arrived unannounced to deliver the finding of the above allegations. LPA met with General Manager, Billy Mitchell.

On 05/24/2024, the Department received the complaint. On 05/29/2024, the initial complaint investigation was conducted. The following documents were obtained to include the resident roster, 7 resident records to include a physician’s report, needs and services plan, progress notes, identification and emergency contact information.

It was alleged that the facility is overcharging residents in care for services they are not providing. It was alleged that resident (R3) is being charged for showers but R3 shower him/herself. Page 1 of 4.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jackie Jin	TELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Christine Kabariti	TELEPHONE: (408) 324-2112
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2025

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 4

Control Number 26-AS-20240524084602

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: 04/09/2025

NARRATIVE

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The review of R3’s records indicates that R3 is paying for shower services as R3 requires moderate assistance with showers.

Based on interview with R3, it was stated that upon admission in the facility (April 2024) R3 was refusing showers due to a fall incident that occurred in another care facility. R3 states he/she was not comfortable with showers yet and refused the shower service. R3 denied the facility missing a shower week, besides one week when the facility did not have hot water which R3 received a shower the week after. R3 states that he/she receives shower weekly and did not have any complaints about the services he/she is receiving.

It was alleged that resident (R4) is being charged for showers and laundry but R4’s family does the laundry and R4 showers him/herself.

The review of R4’s records indicates that R4 is not paying for shower services and requires minimal assistance with showers. Records show that R4 is paying for weekly laundry services.

Based on interview with R4, it was stated that R4 shower him/herself. R4 stated that the staff does his/her laundry weekly and did not have any complaints about the services he/she is receiving.

It was alleged that resident (R5) is receiving shower services but is being charged for dressing services, when R5 can dress him/herself.

The review of R5’s records indicates that R5 is paying for shower services as R5 requires moderate assistance with showers. R5 is independent in dressing and is not paying for this service.

Page 2 of 4.

SUPERVISOR'S NAME: Jackie Jin	TELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Christine Kabariti	TELEPHONE: (408) 324-2112
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 26-AS-20240524084602

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: 04/09/2025

NARRATIVE

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Based on interview with R5, it was stated that R5 received weekly shower services since the day R5 has moved in. R5 denied the staff missing a shower week. R5 states he/she is able to dress him/herself daily but sometimes may need assistance from the staff. R5 did not have any complaints about the services and care he/she is receiving and states the facility is meeting his/her daily needs.

It was alleged that the facility staff are falsifying documents because the staff are making the residents sign documents that has been written by staff to be completely untrue. It was also alleged that staff are falsifying documents as they are told by S1 to not to document everything because it leaves a paper trail.

4 residents were interviewed. Based on resident interview, 4 out of 4 resident’s denied staff falsifying their documents.

4 staff members were interviewed. Based on staff interview, it was stated by staff (S3) that a former staff was told not to document everything because it leaves a paper trail and S1 does not want a paper trail. Another staff stated that S1 instructed S2 to falsify other documents (pendant log) during a licensing visit. Based on interview with S1 and S2, both staff denied falsifying documents.

S1 stated that a former staff was claiming that he/she was told not to document anything, when the documentation actually needed to be completed by another staff member. S1 also denied instructing S2 to falsify the pendant logs.

Based on interview with the former staff, it was stated that he/she was told by another staff (name unknown) that S1 had directed the other staff to falsify documents.

Based on interview with S2, it was stated that S2 was helping to print the pendant logs. S2 denied S1 instructing him/her to falsify the pendant log by changing the times and believes they are not able to modify the times in the pendant system.

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SUPERVISOR'S NAME: Jackie Jin	TELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Christine Kabariti	TELEPHONE: (408) 324-2112
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 26-AS-20240524084602

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: 04/09/2025

NARRATIVE

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It was alleged that staff (S1) did not keep resident’s information confidential by disclosing a resident’s death to other residents.

3 staff members (S2 – S4) were interviewed. Based on staff interview, 3 out of 3 staff stated that the residents found out about another resident’s death by staff (S1). It was stated that S1 disclosed the information to resident (R1) and (R2).

Based on interview with S1, S1 denied disclosing a resident’s death to other residents.

2 residents (R1 – R2) were interviewed. Based on resident interview, R1 and R2 denied staff disclosing a resident’s death to them. R1 and R2 states they found out about the resident’s death through other residents at the facility, and not by the staff.

The Department has investigated the above allegations. Based on interview, record review and observation the above allegations are unsubstantiated. An unsubstantiated finding indicates that although the allegations are 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 4 of 4.

SUPERVISOR'S NAME: Jackie Jin	TELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Christine Kabariti	TELEPHONE: (408) 324-2112
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2025

LIC9099 (FAS) - (06/04)

Page: 4 of 4