435202807-4-9-2026-26-AS-CKAI-DU7T2W-20260518142122

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202807
Report Date: 04/09/2026
Date Signed: 04/09/2026 02:11:17 PM

Unsubstantiated

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
01/02/2026 and conducted by Evaluator Marcela Yanez

COMPLAINT CONTROL NUMBER: 26-AS-20260102141149

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: 92	DATE:	04/09/2026
		UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Eva Reiter and Brittney Leonard		TIME COMPLETED:	02:20 PM

ALLEGATION(S):

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Facility charging services not stated on the admission agreement.

INVESTIGATION FINDINGS:

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Licensing Program (LPA) Analyst Marcela Yanez conducted an unannounced complaint investigation visit to deliver findings. LPA announced the purpose of the visit and met with Brittnay Leonard, Memory Care Director MCD and Eva Reiter, Resident Care Director RCD, GM was not in the office.

On January 2, 2026, the department received a complaint with the allegation that the Facility was charging for services not stated on the admission agreement.

On 01/08/26 LPA Yanez conducted an initial 10-day complaint investigation visit and a continued complaint visit on 02/25/26. LPA reviewed residents file, admissions agreement, level of care plan, resident progress notes, change in service agreement, and billing ledger.

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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026

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-20260102141149

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: 04/09/2026

NARRATIVE

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During the investigation the department interviewed General Manager (GM) and 1 staff.
Resident (R1) moved into facility on 01/29/21 and entered into agreement with a signed admissions agreement. When R1 moved into the facility he/she had a level 5 care, then on 05/24/21 it increased to level 6 then was lowered to level 2 on 8/25/21.

On 10/22/21 R1 was credited for level 6 care for $6461.08 for previous months when level 2 care was to be applied. R1 was charged for level 2 care for $3341.94 on 10/22/21. On 03/17/23 R1 had an increase in level of care status to level 3 until 06/26/23 when it was reduced to level 1 care. R1s level of care increased again on 10/12/23 to level 6 until it was reduced to level 2 on 11/01/23.

GM stated that R1s level of care was documented and signed every time R1 had an increase in level of care and placed in residents file. R1 also signed every level of care plan change. GM stated R1 was notified every time the level of care increased or decreased. GM stated per facility policy every level of care change is documented and signed by the GM and the Resident.

LPA Yanez reviewed R1s ledger and verified all charges on the ledger were agreed upon when R1 entered into an admissions agreement dated 01/29/21. R1 was charged and credited accordingly for services when there was an increase or decrease in level of care.

On 02/10/26 R1 became in agreement with the facility to pay a total final balance of $9006.10 after the facility gave a credit of $1500.00 as a courtesy to settle the final bill. Based on documentation R1 received services he/she agreed upon and paid for according to the admissions agreement.

On 04/09/26 the department has completed its investigation.

Based on investigation, interviews conducted, and records reviewed, the Department found that the above allegation is 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.

This report was reviewed with MCD and RCD, and a copy of the report was provided.

SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026

LIC9099 (FAS) - (06/04)

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