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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202807
Report Date: 08/04/2025
Date Signed: 08/04/2025 12:12:23 PM

Substantiated


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
02/13/2024 and conducted by Evaluator Manuel Monter
COMPLAINT CONTROL NUMBER: 26-AS-20240213143445
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: 82DATE:
08/04/2025
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Administrator Ida Gemignani-stearns.TIME COMPLETED:
12:25 PM
ALLEGATION(S):
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Facility has cockroaches in resident room.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Monter conducted an unannounced complaint inspection to deliver the findings on the above allegation. LPA met with Administrator Ida Gemignani-stearns.

On February 13, 2024, the Department received a complaint alleging Facility has cockroaches in resident room.

On December 15, 2023, LPA Christine Dolores interviewed resident R1-R5. R1 stated he/she has observed cockroaches and fruit flies inside his/her apartment. R2-R5 stated they haven’t seen pests in their apartment.

LPA Dolores interviewed staff S2-S5. Staff S2 & S4 stated they have not seen pests in residents bedrooms. Staff S3 stated resident R1’s bedroom sometimes has cockroaches. S5 stated 4 resident bedrooms have cockroaches. Page 1 Out of 3.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2025
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-20240213143445
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: 08/04/2025
NARRATIVE
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On May 8, 2024, LPA Simi Rai interviewed Former administrator Will Carter, referred to as S1. S1 stated he/she has reached out to Orkin since facility has an existing contract. S1 stated they have used Orkin to thoroughly cleaning of resident's apartment. S1 stated cockroaches will come back after treatment since resident leaves food out in the room. S1 stated Orkin has been 4 times for R1’s bedroom. S1 stated R1 has allowed housekeeping to come once a week to clean his/her room and he/she has not refused any service.

LPA Rai interviewed facility Maintenance Director (MD) Ollie Moor Jr. MD stated the pests issues have been ongoing for a year. MD stated the facility staff always clean R1’s room and the pest control folks go into R1’s room for treatment. MD stated R1 leaves food around and had conversations about leaving food around. MD stated there is regular housekeeping once a week. MD stated they will clean the room further so the issue isn't persistent, but the issue are the days that housekeeping doesn't come into the room.

LPA Rai interviewed staff S6. S6 stated there has been a long-standing issue with roaches in R1’s apartment. S6 stated R1 has not refused to have housekeeping come in the room. S1 stated there always is a bag of candy and there are always wrappers near R1’s wheelchair on the floor so the sweet candy is attracts the cockroaches.

On May 28, 2025, LPA Manuel Monter interviewed residents R6-R12. Residents R6-R12 stated they haven’t seen cockroaches or pests in the facility.

LPA Monter interviewed ADM. ADM stated R1’s room had cockroaches, but she hasn’t seen them. ADM stated the facility has had exterminators come out to address the issue.

On May 28 and June 6, 2025 LPA Manuel Monter interviewed staff S7-S11. S7 stated he/she hasn’t seen any pests inside the facility. S8 stated he/she has seen many cockroaches and ants in the kitchen. S9 stated he/she has observed ants in the memory care kitchen. S10 stated he/she has seen cockroaches in R1’s bedroom and a bedroom adjacent to R1’s bedroom. S11 stated he/she observed cockroaches in the memory care unit. S11 stated she has brought up this issue to management, but management has not addressed it. S12 stated there was a report in November 2024, that the memory care unit of the facility had cockroaches. S12 stated they have hired pest control, which addressed the issue. Page 2 Out of 3.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 26-AS-20240213143445
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: 08/04/2025
NARRATIVE
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On July 11, 2025, LPA Manuel Monter interviewed Staff S1. S1 stated due to R1’s condition R1 had difficulty cleaning up for him/herself. S1 stated R1 did not have any behaviors that would cause his/her bedroom to become dirty. S1 stated they were aware of R1’s troubles with being able to clean up for him/herself. S1 stated they also offered additional housekeeping for R1. S1 stated R1’s family member was also informed about the infestation. S1 stated R1 declined additional housekeeping services. R1 stated he/she didn’t want to pay for additional charges.

S1 stated In April 2024, they did ask orkin to treat the apartment. S1 stated this was where they needed to vacate the entire apartment, and the room had to be empty for 8 hours.

Based on record review, the facility has a contract with Orkin. The service agreement states, “Orkin agree to provide Pest control service (Control means the periodic eradication of existing infestations within practical limits) for control of the following pests: Roaches, ants, silverfish, rats & mice.”

Based on records reviewed, the facility has invoices for Orkin services from January 2023- December 2024.

Based on the investigation, although the facility maintained a contract with Orkin for regular pest control services, it did not ensure R1’s bedroom was free of cockroaches. This posed an immediate health, safety and personal rights risk to R1 and other residents in the facility.

Based on interviews and documents review the preponderance of evidence standard has been met therefore the above allegations is found to be SUBSTANTIATED.

An initial complaint allegation on pests was received by the Department on 12/05/2023. Although this complaint investigation was found to be substantiated, the same allegation was also reported on 02/13/2024 and 04/30/2024, while the initial complaint was still under investigation. A deficiency citation was issued in response to the initial complaint; therefore, the complaints received on 02/13/2024 and 04/30/2024 are both substantiated but considered a continuation of the same pest related allegation in 12/05/2023.

Page 3 Out of 3. End of Report.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3