435202807-6-20-2025-26-AS-KHOS-DJDL2F-20250708082217

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202807
Report Date: 06/20/2025
Date Signed: 06/20/2025 11:30:20 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
02/06/2024 and conducted by Evaluator Manuel Monter

COMPLAINT CONTROL NUMBER: 26-AS-20240206154903

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: 76	DATE:	06/20/2025
		UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Resident Care Director Michael Lucio		TIME COMPLETED:	11:40 AM

ALLEGATION(S):

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Facility staff are threatening resident with eviction.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Manuel Monter arrived unannounced to the facility to deliver complaint investigation findings. LPA met with Resident Care Director Michael Lucio and explained the purpose of the visit.

On February 6, 2024, the Department received a complaint alleging Facility staff are threatening resident with eviction.

On February 16, 2024, LPA Simranjit Rai interviewed Staff 1 (S1). S1 reported that the facility has not initiated the eviction process for Resident 1 (R1) although R1 has a past due charges. According to S1, S1 informed R1 and R1’s family member regarding the past due charges and did not hear from the family member. S1 had a meeting with R1 and explained the process of an eviction if the resident does not pay the past due balance. Page 1 Out of 2.

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: 06/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2025

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 2

Control Number 26-AS-20240206154903

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: 06/20/2025

NARRATIVE

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On February 27, 2024, LPM Romeo Manzano interviewed S1. S1 stated R1 has had a past due balance since December of 2021. S1 stated the facility has not issued an eviction notice, nor have they issued him a 60 day notice increase of rent for 2024.

According to an interview with Staff 2(S2), S2 stated according to the facility records R1 has received facility services, notice of rental increases, reached out to R1's responsible party, and has continued to provide services.

On February 21, 2025, LPA Valerio interviewed R1. R1 stated R1 is moving out next month. R1 has continued to live at the facility since 2021. R1 stated the reason for moving next month was because the facility cannot "take care of me".

On May 28, 2025, Licensing Program Analyst Manuel Monter interviewed residents R2-R9. All residents interviewed stated they have not heard or seen staff threaten residents with eviction.

LPA interviewed facility ADM. ADM stated she has not seen or heard staff threatening residents with eviction.

On May 28 & June 16, 2025, LPA interviewed staff S3-S9. All staff interviewed stated they have not heard or seen staff threaten residents with eviction.

Based on a review of an email communication, resident R1 sent an email to the facility on, February 15, 2024, informing them that he/she was giving his/her 30 day notice and was moving out.

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 2 Out of 2. END OF REPORT.

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (408) 388-2297
LICENSING EVALUATOR NAME: Manuel Monter	TELEPHONE: (408) 324-2112
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2025

LIC9099 (FAS) - (06/04)

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