435202807-6-6-2025-26-AS-RMAO-DHXUZA-20250624160109

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202807
Report Date: 06/06/2025
Date Signed: 06/06/2025 11:30:28 AM

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
11/30/2023 and conducted by Evaluator Manuel Monter

COMPLAINT CONTROL NUMBER: 26-AS-20231130094329

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: 80	DATE:	06/06/2025
		UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Administrator Ida Gemignani-stearns		TIME COMPLETED:	11:35 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff are not assisting resident(s) with showering.
Facility staff are not assisting resident(s) with wheelchair transfers.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Monter conducted an unannounced complaint inspection to deliver the findings on the above allegation. LPA met with ADM Ida Gemignani-stearns

On November 30, 2023, the Department received a complaint alleging Facility staff are not assisting resident(s) with showering/ Facility staff are not assisting resident(s) with wheelchair transfers. It has been alleged that residents are not getting the staff assistance they need be able to shower or get in and out of their wheelchairs.

On December 7, 2023, LPA Simi Rai interviewed residents R1-R4. R1 stated he/she receives help with showers, with no issues. R1 stated he/she doesn’t need transfer assistance, but hasn’t heard any residents not receiving help to transfer from their wheel chair. Page 1 Out of 3.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (408) 388-2297
LICENSING EVALUATOR NAME: Manuel Monter	TELEPHONE: (408) 324-2112
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2025

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 5

Control Number 26-AS-20231130094329

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 WILLOW GLEN	FACILITY NUMBER: 435202807
	VISIT DATE: 06/06/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

R2 stated he/she does not need assistance with showers but staff will help his/her showers if he/she needs it. R2 stated she hasn’t heard anything about a resident with a wheelchair needing help with a shower and not receiving it.

R3 stated the staff giver him/her showers, no issues. R3 stated staff assist her with transfers, with no complaints. R4 stated he/she receives help from staff with his/her showers, with no issues. R4 stated she hasn’t heard about residents with wheelchairs, needing transfers into showers having any issues.

LPA Rai interviewed General Manager (GM), Will Carter. GM stated staff have not reported any incidents where resident was not assisted with showers and wheelchair transfers.

LPA Rai interviewed staff S1-S5. S1 stated all residents receive their showers and receive help transferring from the wheel chair to the shower. S2 does not recall a time when a resident on a wheelchair was not given a shower because the staff did not assist the resident. S3 stated the only way a resident doesn’t receive a shower is when the resident refuses to be given a shower. S3 stated there hasn’t been any incidents regarding a resident with a wheelchair. S4 stated residents who need 2-3 staff assistance with showers, are provided assistance. S5 stated he/she will encourage the residents to shower and if the resident refuses a shower, he/she will reschedule the shower with them.

On May 28, 2025, LPA Manuel Monter interviewed residents R5-R11. R5 stated he/she does get assistance with his/her shower, but it can be delayed up to an hour. R6 stated he/she doesn’t need assistance with showers. R5, R6 and R11 stated he/she does need assistance with transfers and has not had any issues with transfers. Residents R7, R8, R9, R10 stated he/she doesn’t need assistance with transfers or showers.

LPA interviewed staff S6-S9. All staff interviewed stated staff assist residents with showers and transfers. All staff interviewed stated there hasn’t been a time when a resident who needed assistance, wasn’t assisted.

Page 2 Out of 3.

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (408) 388-2297
LICENSING EVALUATOR NAME: Manuel Monter	TELEPHONE: (408) 324-2112
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 26-AS-20231130094329

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 WILLOW GLEN	FACILITY NUMBER: 435202807
	VISIT DATE: 06/06/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

LPA Monter interviewed facility Administrator (ADM) Ida Gemignani-Stearns. ADM stated residents are given showers without any issues. ADM stated there hasn’t been any misses. ADM stated she hasn’t heard about any issues. ADM stated the residents are getting assistance with transferring. ADM stated there hasn’t been a time when residents who needed to be transferred were neglected.

On June 6, 2025, LPA Monter interviewed Staff S10. S10 stated residents are given showers without any issues or misses. S10 stated residents are getting assistance with transfers. S10 stated residents are not being neglected their shower or transfers.

The Department has completed the investigation of the above allegations. Based on interviews conducted and records review, the department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis.

Page 3 Out of 3.

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (408) 388-2297
LICENSING EVALUATOR NAME: Manuel Monter	TELEPHONE: (408) 324-2112
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 5

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
11/30/2023 and conducted by Evaluator Manuel Monter

COMPLAINT CONTROL NUMBER: 26-AS-20231130094329

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:	DATE:	06/06/2025
		UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Administrator Ida Gemignani-stearns		TIME COMPLETED:	11:35 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff are not dispensing medications as prescribed.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On November 30, 2023, the Department received a complaint alleging Facility staff are not dispensing medications as prescribed.

On December 7, 2023, LPA Simi Rai interviewed residents R1-R4. Residents R1, R3 & R4 stated he/she is receiving his/her medication daily with no issues. R2 stated he/she takes his/her own medication.

LPA Rai interviewed General Manager (GM), Will Carter. GM stated there are No incidents regarding medications have been reported to GM.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (408) 388-2297
LICENSING EVALUATOR NAME: Manuel Monter	TELEPHONE: (408) 324-2112
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2025

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

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 26-AS-20231130094329

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 WILLOW GLEN	FACILITY NUMBER: 435202807
	VISIT DATE: 06/06/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

LPA Rai interviewed staff S1-S5. S1 and S3 and S5 stated he/she doesn’t know about residents medication administration, as their jobs do not entail medication administration. S2 stated there has been no issues with medication administration, and medications are only not administered if a resident refuses or the resident left the facility to an appointment without letter the facility know about the leave. S4 stated medications are administered on time.

On May 28, 2025, LPA Manuel Monter interviewed residents R5-R11. R5 and R9 stated he/she is getting his/her medication daily, with no issues. R6 and R7 and R8 R10 R11 stated he/she handles his/her own medication and doesn’t need assistance from staff.

LPA interviewed staff S6-S9. 3 Out of 4 staff interviewed (S6,S8,S9) stated residents are getting the medications every day, on time.

S7 stated there have been times when medication was administered late. S7 stated medication that needs to be administered at 6am, was given at 10:30am. S7 stated this happens when there is only 1 medtech for both the memory care and assisted living.

LPA Monter interviewed facility Administrator (ADM) Ida Gemignani-stearns . ADM stated he/she residents are getting his/her medication on time. ADM stated there are no issues regarding residents getting their medication. ADM stated she is not aware of any issues or delays regarding medication administration.

On June 6, 2025, LPA Manuel Monter interviewed staff S10. S10 stated that residents are getting their medications as per physicians orders. S10 stated there hasn't been a time when residents didn't get their medication administered or delayed.

Based on investigation, records reviewed, and interviews conducted, the Department found that the above allegations are UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegations did or did not occur.

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (408) 388-2297
LICENSING EVALUATOR NAME: Manuel Monter	TELEPHONE: (408) 324-2112
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2025

LIC9099 (FAS) - (06/04)

Page: 5 of 5