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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320089
Report Date: 02/25/2026
Date Signed: 02/25/2026 03:30:08 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 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
01/20/2026 and conducted by Evaluator Socorro Leandro
COMPLAINT CONTROL NUMBER: 11-AS-20260120120410
FACILITY NAME:MERRILL GARDENS AT ROLLING HILLS ESTATESFACILITY NUMBER:
198320089
ADMINISTRATOR:TRACEY E HOLDERFACILITY TYPE:
740
ADDRESS:627 SILVER SPUR RDTELEPHONE:
(310) 974-3339
CITY:ROLLING HILLSSTATE: CAZIP CODE:
90274
CAPACITY:150CENSUS: 99DATE:
02/25/2026
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:General Manager - Tracey MallaretTIME COMPLETED:
03:40 PM
ALLEGATION(S):
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Staff did not dispense medications as prescribed
INVESTIGATION FINDINGS:
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On 2/25/2026, Licensing Program Analyst (LPA) Socorro Leandro conducted an unannounced continuation complaint investigation visit regarding the allegation listed above. LPA met with the General Manager, Tracey Mallaret, and the purpose of the visit was explained. LPA was granted entry to the facility.

Investigation consisted of the following:

On 1/22/2026, Witness 1 (W1) was interviewed. On 1/26/2026, interviews were conducted, medications along with Medication Administration Records (MARs) were reviewed, and records were gathered. Staff 1 (S1) to Staff 5 (S5) were interviewed. Facility records were gathered which consisted of Resident Roster dated 1/23/2026, Personnel Report dated 1/26/2026, Staff Trainings, MARs, Unusual Incident/Injury Reports (UIRs) and other pertinent records were provided. On 2/25/2026, interviews were conducted, medications along with MARs were reviewed, and records were reviewed. Staff 2 (S2), S5, Staff 6 (S6), and Staff 7 (S7) were interviewed.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2026
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 3
Control Number 11-AS-20260120120410
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: MERRILL GARDENS AT ROLLING HILLS ESTATES
FACILITY NUMBER: 198320089
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/25/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/25/2026
Section Cited
CCR
87465(a)(4)
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87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed.

This requirement is not met as evidenced by:
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The facility informed R1’s & R2’s responsible party, physicians, hospice, facility staff, retrained staff, and submitted Unusual Incident Reports to the Department. The facility retrained staff on

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Based on records review and interviews conducted, the licensee did not comply with the section cited above in not providing Resident 1 and Resident 2 with medications as prescribed on 01/03/2026, which poses a potential health, safety or personal rights risk to persons in care.
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Medication Administration on 1/21/2026.

Copies of POCs have been provided to LPA Socorro Leandro.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20260120120410
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: MERRILL GARDENS AT ROLLING HILLS ESTATES
FACILITY NUMBER: 198320089
VISIT DATE: 02/25/2026
NARRATIVE
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Investigation revealed the following

Allegation: “Staff did not dispense medications as prescribed”, it is being alleged that the facility has made medication errors. Interviews conducted with S1 to S7 revealed the following: 7 out of 7 staff agreed with the allegation. Interviews conducted with W1 revealed the following: 1 out of 1 witness agreed with the allegation. UIRs for Resident 1 (R1) and Resident 2 (R2) revealed the following: On 1/3/2026, R1 received R2’s medication in error; R2 did not receive their noon medication as prescribed; the facility contacted R1’s and R2’s responsible party, physician, hospice, facility staff, and retrained staff who committed medication error. Progress Notes for R1 and R2 revealed the following: On 1/3/2026, facility staff conducted an investigation and found that R1 was provided with two medication tablets that belong to R2 during noon time, and R2 did not receive their scheduled noon medication. Staff trainings revealed the following: The staff who committed the medication error was retrained on “Skills Evaluation-Medication Assistance” dated 1/7/2026. The facility retrained staff on “Annual Medication Training” on 1/21/2026. Substantiated: Based on interviews and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D.

An exit interview was conducted, and a plan of correction was developed. Appeal Rights and a hard copy of this report were provided to General Manager, Tracey Mallaret.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3