435202807-3-13-2025-26-AS-KHOS-DFBMJ3-20250401093829

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202807
Report Date: 03/13/2025
Date Signed: 03/13/2025 03:02:54 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
12/21/2023 and conducted by Evaluator Dominic Tobola

COMPLAINT CONTROL NUMBER: 26-AS-20231221215159

FACILITY NAME:	MERRILL GARDENS AT WILLOW GLEN		FACILITY NUMBER:	435202807
ADMINISTRATOR:	GOLDEN, KIM		FACILITY TYPE:	740
ADDRESS:	1420 CURCI DRIVE		TELEPHONE:	(408) 283-0941
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95126
CAPACITY:	150	CENSUS: 87	DATE:	03/13/2025
		UNANNOUNCED	TIME BEGAN:	10:07 AM
MET WITH:	Will Carter, General Manager		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Staff are overcharging a resident for services not received

INVESTIGATION FINDINGS:

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On 3/13/2025, Licensing Program Analyst (LPA) Tobola arrived unannounced for the purpose of delivering complaint investigation findings and was greeted by General Manager, Will Carter The department toured the facility, interviewed staff, outside parties, reviewed records and made observations during the course of the investigation.

Complaint alleges staff are overcharging a resident for services not received with R1 required by facility to pay for unexplained rental fees. Based upon department conducted interviews with resident (R1, R2 & R3) there were no indications that staff were not meeting resident level of care needs. Interviews with former Executive Director (S1) and Business Office Manager (S2) indicated that R1 had been admitted to the facility in January 2021. Based upon review of R1’s payment ledger for rental and care fees, LPA found that R1 had outstanding fees owed to the facility. As a result, additional late fees accrued which increased the total amount of R1's total fees owed.

The agency has investigated the allegation and we have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. No deficiencies cited.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Andrea Medlin	TELEPHONE: (650) 266-8811
LICENSING EVALUATOR NAME: Dominic Tobola	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025

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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