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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200879
Report Date: 10/24/2025
Date Signed: 10/24/2025 12:05:10 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/26/2023 and conducted by Evaluator Kelly Nguyen
COMPLAINT CONTROL NUMBER: 15-AS-20230626155421
FACILITY NAME:MERRILL GARDENS AT ROCKRIDGEFACILITY NUMBER:
019200879
ADMINISTRATOR:REDDY, ANNAFACILITY TYPE:
740
ADDRESS:5238 CORONADO AVETELEPHONE:
(510) 338-4543
CITY:OAKLANDSTATE: CAZIP CODE:
94618
CAPACITY:150CENSUS: 123DATE:
10/24/2025
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Niare Feaster, General Manager TIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Unqualifed staff are administering medication(s) to residents in care.
Facility staff falsify documents/records.
INVESTIGATION FINDINGS:
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On 10/24/2025 at 11:30AM, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to deliver investigation findings to General Manager (GM) Niare Feaster and explained the purpose of the visit.

Allegation: Unqualified staff are administering medication(s) to residents in care – Unsubstantiated

During the course of the investigation, interviews were conducted with staff. On 6/29/2023 a random sample of 5 staff records are reviewed including but not limited to staff training records, medication administration records (MARs), and personnel files. The review showed that staff responsible for medication assistance had current medication training and were listed on the facility’s staff roster as authorized to assist residents with medication. No evidence was found indicating that unqualified or untrained staff administered medicines to residents.

Report continues on LIC 9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2025
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 15-AS-20230626155421
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: MERRILL GARDENS AT ROCKRIDGE
FACILITY NUMBER: 019200879
VISIT DATE: 10/24/2025
NARRATIVE
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Although the allegation may have occurred, there is not a preponderance of evidence to support that unqualified staff are administering medication(s) to residents in care. Therefore, the allegation is deemed unsubstantiated.

Allegation: Facility staff falsify documents/records- Unsubstantiated

During the course of investigation, interviews were conducted with facility staff, and reviewed facility records, including but not limited to staff schedules, medication logs, were reviewed for accuracy and consistency. No discrepancies or evidence of falsified documentation were identified. Records appeared to be properly maintained, accurate, and consistent with information obtained during interviews. Therefore, allegation is Unsubstantiated.

Although the allegation may have occurred, there is not a preponderance of evidence to support that facility staff falsified documents or records. Therefore, the allegation is deemed unsubstantiated.

Exit interview conducted and a copy of this report provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2