435202806-10-7-2024-26-AS-KHOS-DA5HHL-20241017061255

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202806
Report Date: 10/07/2024
Date Signed: 10/07/2024 03:15:25 PM

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
04/04/2023 and conducted by Evaluator Christine Dolores

COMPLAINT CONTROL NUMBER: 26-AS-20230404153129

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: 141	DATE:	10/07/2024
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Billy Mitchell		TIME COMPLETED:	03:20 PM

ALLEGATION(S):

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Facility staff does not treat residents in a polite manner.
Facility staff verbally abuse residents.
Facility staff physically abuse residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to deliver the findings for the above allegations. LPA met with General Manager Billy Mitchell and Resident Care Director Jocelyne Bailon Solache.

On 04/04/2023, the Department received the complaint. On 04/12/2023, the initial complaint investigation was conducted. Documents were obtained to include the staff schedule and R1 - R7's physician's report, appraisal needs and services plan, and emergency contact form.

It was alleged that the facility staff do not treat residents in a polite manner, facility staff verbally abuse residents and facility staff physically abuse residents. No names of specific residents or staff members were disclosed. PAGE 1.

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2024

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

LIC9099 (FAS) - (06/04)

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Control Number 26-AS-20230404153129

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: 10/07/2024

NARRATIVE

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On 04/12/2023, 7 residents were interviewed. Based on resident interview, 7 out of 7 residents did not have any complaints of staff not treating them politely. 7 out of 7 residents denied staff being verbally and physically abusive to them. 7 out of 7 residents denied the observation of staff being verbally or physically abusive to other residents.

On 10/07/2024, 5 staff members were interviewed. Based on staff interview, 5 out of 5 staff member denied the observation or knowledge or staff not treating residents politely. 5 out of 5 staff denied the observation of staff being verbally or physically abusive to the residents.

Based on record review, the Department did not receive any reports relating to these allegations.

The Department has investigated the above allegations and 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 General Manager Billy Mitchell and a copy of the report was provided.

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SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2024

LIC9099 (FAS) - (06/04)

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