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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202807
Report Date: 07/11/2025
Date Signed: 07/11/2025 02:01:13 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
10/24/2024 and conducted by Evaluator Marcela Yanez
COMPLAINT CONTROL NUMBER: 26-AS-20241024103221
FACILITY NAME:MERRILL GARDENS AT WILLOW GLENFACILITY NUMBER:
435202807
ADMINISTRATOR:GOLDEN, KIMFACILITY TYPE:
740
ADDRESS:1420 CURCI DRIVETELEPHONE:
(408) 283-0941
CITY:SAN JOSESTATE: CAZIP CODE:
95126
CAPACITY:150CENSUS: DATE:
07/11/2025
UNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Ida Gemignani-Stearns, General Manager.TIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Licensee did not ensure the facility is in good repair at all times.
Food of good quality was not served due to the food being served cold.
Staff did not assist residents with transportation needs.
Facility did not ensure the resident was accorded dignity due to the staff being rude to the resident in care.
Facility did not ensure a healthful and comfortable accommodation due to the resident's toilet being too small.
INVESTIGATION FINDINGS:
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On 07/11/25 Licensing Program Analyst (LPA) Marcela Yanez conducted an unannounced visit to deliver the findings of the complaint investigation. LPA stated the purpose of the visit and met with Ida Gemignani-Stearns, General Manager.

On 10/24/2024 the department received a complaint with the above allegations.

On 10/31/2024, the Department conducted an unannounced initial complaint investigation visit. During the visit the Department interviewed the Administrator (ADM), and 7 staff (S1-S7) and 4 residents (R1-R4). LPAs obtained 2 Resident's Physicians Report, Appraisal and Needs and Services Plan.

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Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2025
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 3
Control Number 26-AS-20241024103221
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: 07/11/2025
NARRATIVE
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on 12/04/24 12 Residents (R1-R12) were interviewed. 12 out of 12 residents stated the staff has never treated them disrespectfully or rudely, residents have always been treated with dignity. 12 out of 12 residents stated they have never had transportation issues and that the van is always available for use when needed and that the front desk can make other transportation arrangements, when necessary and when the driver is unavailable or on vacation. 12 out of 12 residents stated, they have not missed any appointments due to no transportation. 12 out of 12 residents stated they have never had issues with food being cold, poor tasting and of low quality.

During the visit LPA Fortes observed food being served and steam coming from the food when uncovered.

During the investigation 6 Staff (S1-S6) were interviewed, including the Executive Director (ED). 6 out of 6 staff stated that the facility has never been in disrepair and if the residents have an issue the facility takes care of it the issue the same day. 6 out of 6 staff stated that the facility does not serve cold food and has quality control procedures to check the food 2 times prior to serving. S4 stated that if the residents want the food warmed, they will always warm it up for them. 5 out of 6 staff stated that they have never seen the staff be rude or disrespectful to the residents in care. 6 out of 6 staff stated the facility has never seen an issue with transportation and that the residence just needs to notify the front desk if they require transportation services outside the scope of the facility transportation services provided.

6 out of 6 staff interviewed stated that if the residents ask for anything the facility will always try to accommodate the residents’ needs in a timely manner, if the issue is related to a clogged sink or plugged up toilet the issue is normally resolved the same day.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 26-AS-20241024103221
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: 07/11/2025
NARRATIVE
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ADM provided documentation of transportation services acquired during the driver’s absence from the facility. ADM also provided documentation showing when a resident’s sink was clogged and plumber fixed the issue in a timely manner. ADM stated that the clogged toilet is an immediate concern due to it being a health and safety issue. ADM stated that the facility staff needs to notify the facility administration 1 month prior to taking vacation or time off and it must be approved prior to employee taking the time off. ADM stated there was a Sunday that the facility was without a driver due to the driver calling in sick and resident’s appointments were changed. ADM stated the facility Maintenance Director had resigned and the Assistant Maintenance Director stepped in to cover while a new Maintenance Director was replaced. ADM stated that if the residents’ room is in disrepair the resident is offered an interim room while their room is repaired.

On 07/11/25 General Manager (GM) Ida Gemignani was interviewed and stated all toilets are at the same height and width they are standard, Resident have the option to purchase a Riser For Seniors the facility does not provide these for health and safety reasons.

Based on investigation, records reviewed, and interviews conducted, the Department found that the above allegations are 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.

No citations noted at today’s compliant investigation visit. Exit interview conducted with Ida Gemignani-Stearns, General Manager. This report was provided to review and for signature. A copy of this report was provided.

End of Report
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2025
LIC9099 (FAS) - (06/04)
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