435202806-9-19-2024-26-AS-KHOS-D9MGJF-20241001052302

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202806
Report Date: 09/19/2024
Date Signed: 09/19/2024 04:55:45 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
12/02/2022 and conducted by Evaluator Christine Dolores

COMPLAINT CONTROL NUMBER: 26-AS-20221202123353

FACILITY NAME:	MERRILL GARDENS AT GILROY		FACILITY NUMBER:	435202806
ADMINISTRATOR:	ATKINSON, DIANE		FACILITY TYPE:	740
ADDRESS:	7610 ISABELLA WAY		TELEPHONE:	(206) 676-5300
CITY:	GILROY	STATE: CA	ZIP CODE:	95020
CAPACITY:	214	CENSUS: 140	DATE:	09/19/2024
		UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Billy Mitchell		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Facility does not have enough staff to meet the needs of residents in care

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Christine Dolores and Marcella Tarin arrived unannounced to deliver the finding of the above allegations. LPAs met with General Manager, Billy Mitchell.

On 12/02/2022, the Department received a complaint alleging the facility’s Garden House section (aka memory care) does not have enough staff to meet the needs of residents in care. On 12/08/2022, the initial complaint investigation was conducted.

The following documents were obtained for this investigation: Garden House schedule from 10/30/2022 – 12/10/2022, memory care resident roster, and 4 resident’s physician’s report, needs and services plan, and monthly task log. PAGE 1 OF 2.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024

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 2

Control Number 26-AS-20221202123353

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: 09/19/2024

NARRATIVE

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On 12/08/2022, 2 staff members were interviewed. Based on interview, in Garden House they normally have about 4 caregivers and 1 medtech per shift and NOC is normally 2 caregivers and 1 medtech. Staff from Assisted Living are pulled, if needed. It was stated that they utilize 1 agency staff in the AM shift at least 2-3 times a week and 2 agency staff in the PM shift at least 2-3 times a week. It was stated that agency staff are normally on the weekends.

It was stated that if they are short staffed or have a call out, their staff either works doubles, leadership staff fills in to cover the shifts, or a staffing agency is contacted.

2 out of 2 staff stated the facility is constantly hiring, and the hiring of new staff is ongoing.

Based on observation, on 12/08/2022 around 10:40AM, LPA Dolores entered the Garden House section. LPA observed 2 caregivers, 1 staff assisting with activities to a group of more than 10 residents, and 1 housekeeper on the floor. It was stated that 2 caregivers and 1 medtech was on break.

Based on record review, there was 35 residents in memory care as of 12/08/2022. The facility’s Garden House schedule showed at least 3-4 caregivers and 1 medtech scheduled daily in the AM and PM. NOC shift shows at least 2 caregivers scheduled.

The Department has investigated the above allegation. Based on interview, record review and observation the above allegation is unsubstantiated. An unsubstantiated finding indicates that although the allegation may have happened, 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 Health Services Director, Jocelyn Bailon and a copy of the report was provided.

SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024

LIC9099 (FAS) - (06/04)

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