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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202807
Report Date: 05/12/2023
Date Signed: 05/12/2023 01:27:47 PM


Document Has Been Signed on 05/12/2023 01:27 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 WILLOW GLENFACILITY NUMBER:
435202807
ADMINISTRATOR:GOLDEN, KIMFACILITY TYPE:
740
ADDRESS:1420 CURCI DRIVETELEPHONE:
(408) 283-0941
CITY:SAN JOSESTATE: CAZIP CODE:
95126
CAPACITY:150CENSUS: 90DATE:
05/12/2023
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
10:29 AM
MET WITH:Corinne GeisTIME COMPLETED:
01:27 PM
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Licensing Program Analyst Ryker Heberle (LPA) conducted an unannounced case management visit on 05/12/2023. LPA met with facility administrator Corinne Geis (Admin). During the course of the investigation, Admin had to leave, and the rest of the investigation was conducted with operations specialist Will Carter (S1).

LPA began investigating claims from external sources that the facility disallowed visitation during a COVID-19 outbreak in February. During investigation, LPA conducted review of facility visitation documentation from 02/2023 to 03/2023. LPA reviewed email blast to all residents and family members of residents. Email correspondence does not indicate or suggest that the facility restricted visitation, but does suggest that family members and residents wear masks and maintain social distancing practices.

Review of facility visitation reports indicate that during the period from 02/24/2023 to 03/02/2023, the facility received 225 visitors during this outbreak period. LPA interviewed 6 facility residents. 6 out of 6 residents interviewed stated that visitation was restricted during initial outbreaks in 2020, but that visitation has not been restricted in any capacity to their knowledge in 2023.

Based off of records review and resident interviews, LPA did not find evidence suggesting that the facility restricted visitation during most recent outbreak.

LPA closed the case management visit. This report was reviewed with facility Operations Specialist Will Carter and a signed copy of the report was provided.
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Ryker HeberleTELEPHONE: 714-328-5152
LICENSING EVALUATOR SIGNATURE:
DATE: 05/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/12/2023
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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