198320089-7-14-2023-11-AS-JHAD-CU9RVJ-20230731132137

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320089
Report Date: 07/14/2023
Date Signed: 07/14/2023 11:36:19 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/08/2023 and conducted by Evaluator Ana Soto

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20230608091820

FACILITY NAME:	MERRILL GARDENS AT ROLLING HILLS ESTATES		FACILITY NUMBER:	198320089
ADMINISTRATOR:	DEBBIE INFIELD		FACILITY TYPE:	740
ADDRESS:	627 SILVER SPUR RD		TELEPHONE:	(310) 750-9877
CITY:	ROLLING HILLS	STATE: CA	ZIP CODE:	90274
CAPACITY:	150	CENSUS: 109	DATE:	07/14/2023
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Yvette Lem - LVN - Director of Care Services		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Staff are mismanaging resident medication.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ana Soto conducted a subsequent complaint investigation to deliver findings and decisions for the allegation listed above. Today’s complaint investigation was conducted with Yvette Lem, LVN -Director of Care Services,

The investigation consisted of following: Interviews and Record reviews. On 06/16/23, LPA Soto conducted interviews with S#1- Executive Director, S#2 - Director of Care Services, & S#3 - S#6, and via telephone S#7 - S#10, and R#1 - R#10. The LPA also requested copies of the following documents: R#1; Face sheets, Admissions agreement, Physicians report, EMars (March, April, May, June 2023) Medication training for S#2, S#3, S#6, S#7, S#8, S#9, & S#10. Copy of Care Manual section (Training for disposing of dropped medication and refused medication by resident.)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ana Soto
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2023

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 11-AS-20230608091820

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: MERRILL GARDENS AT ROLLING HILLS ESTATES	FACILITY NUMBER: 198320089
	VISIT DATE: 07/14/2023

NARRATIVE

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Based on the LPA's investigation, the investigation revealed the following. For Allegation – Staff are mismanaging resident medication. Interviews conducted with S#1, S#2, S#3, S#6 - S#10, communicated that they follow the procedures they were taught by the facilities video training's and the job training. If at anytime the residents medication is refused by resident, staff will document it on the 24 hour communication log and advise their PCP & responsible party about the refused medication and destroy the medication. If the medication is spilled by staff or resident, they must call the pharmacy and get a one day replacement medication, documented in the 24 hour communication log and dispose of medication. S#2, S#3, S#6, S#7, S#8, S#9, S#10, all deny spilling any residents medication. S#4 & S#5, also communicated that they have never seen any staff member spill residents medications. Interviews with R#1 - R#10, communicated that the staff has never mismanaged their medication, they all know what they are doing. They always get their medication on time, never missed, or have staff member refuse them their medication. LPA reviewed the facility Resident Care Manual were it states how refused and/or spilled medication should be processed. Based on the review of the Resident Care Manual, the staff are following the procedures for refused and/or spilled medication. LPA reviewed staff medication training's, they have all completed the training's. The interviews and records reviewed do not concur with the above allegation.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated

An interview was conducted with Yvette Lem - LVN - Director of Care Services, and a hard copy of report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ana Soto
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2023

LIC9099 (FAS) - (06/04)

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