435202807-1-6-2026-26-AS-RMAO-DQNW2G-20260125155419

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202807
Report Date: 01/06/2026
Date Signed: 01/06/2026 02:54:53 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
09/02/2025 and conducted by Evaluator Maria Partoza

COMPLAINT CONTROL NUMBER: 26-AS-20250902112832

FACILITY NAME:	MERRILL GARDENS AT WILLOW GLEN		FACILITY NUMBER:	435202807
ADMINISTRATOR:	GOLDEN, KIM		FACILITY TYPE:	740
ADDRESS:	1420 CURCI DRIVE		TELEPHONE:	(408) 283-0941
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95126
CAPACITY:	150	CENSUS:	DATE:	01/06/2026
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Ida Gemignani Stearnsm General Manager		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff do not ensure facility is kept free from pests for residents in care.
Staff do not ensure residents are kept free from being malodorous.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced visit to deliver the findings of the complaint received by the Department on 09/02/2025. LPA met with administrator/general manager (ADM/GM) Ida Gemignani-Stearns and stated the purpose of the visit.

The investigation included physical inspections, interviews with residents, staff, and hospice personnel, and review of submitted evidence.

On 09/05/25, the Department inspected five memory care rooms (R1–R5) with ADM present, checking floors, bathrooms, walls, and areas around beds for pests. No ants or foul odors were observed. During the visit, staff were serving snacks to ambulatory residents, and one resident was having a meal in their room assisted by a staff.

page 1 of 3 - see LIC 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Maria Partoza
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2026

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 26-AS-20250902112832

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: 01/06/2026

NARRATIVE

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During the visit on 09/05/25, LPA interviewed 5 residents (R1 to R5) in memory care and 3 out of 5 residents stated they have not seen or experienced ants crawling on them, nor have they seen an infestation of ants in their room. 2 Out of 5 were asleep and resting at the time of the visit and could not be interviewed. All other residents were busy with the activity at the time of the visit.

On 09/09/25, the Department interviewed Witness 1 (W1) by phone. W1 stated he /she is an independent advocate for residents, not affiliated with Long Term Care Ombudsman (LTCO), any non-profit organization, church, or the facility. W1 is a friend of Resident 1 (R1) and does not hold power of attorney (POA).

Witness 1 (W1) stated that on 09/02/25 at about 07:15, he/she visited R1 and found a “huge trail of ants” around the bathroom sink. W1 cleaned the area and notified staff. Around 07:25, hospice arrived, and W1 helped wake R1. W1 noticed a foul odor (feces) and ants along the wall. W1 cleaned ants with Windex and paper towels, removed R1’s sheet, and saw ants starting on the bed. W1 attempted to take a photo but it was unclear. Ants were on the sheet and bed chucks according to W1, and ants were attracted to feces that staff had not cleaned, as stated by W1.

Based on video clips sent to the department by W1, ants can be seen on the video clip and 1 (one) ant on the leg of a person, there was 1 (one) ant on the bed sheet crawling and several ants on the base of a wall. Several ants on the bathroom sink can also be seen. Which according to W1 was expeditiously cleaned and eliminated.

On 10/07/25, the Department continued with the investigation and interviewed staff 1 to 3 (S1 to S3), Administrator (ADM) and hospice care staff (HCS).

ADM stated R1 recently passed away with R1s POA and W1 at bedside. R1 was moved to memory care due to declining health, hospice was initiated by medical providers and per POLST the primary goal is comfort focus treatment signed by the POA. ADM confirmed staff addressed ants reported in R1’s room.

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SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Maria Partoza
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 26-AS-20250902112832

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: 01/06/2026

NARRATIVE

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HCS stated that the facility monitored R1 every two hours. HCS visited 2–3 times weekly, with a Home Health Aide (HHA) staff also involved. During visits, R1 was attended to, and no ants were observed on bedding or body. R1 received hospice comfort care due to end-of-life status. On one occasion, staff promptly cleaned R1 after a bowel movement. HCS stated R1 was not left in soiled conditions during visits. Photos submitted by W1 to HCS showed no ants. R1 remained alert and able to express needs.

S1, S2, and S3 confirmed ants were only found in a room near the kitchen due to stored chocolates; the area was cleaned and fumigated, and no ants were observed in R1’s room, bedding, or body. Staff reposition R1 every 1.5–2 hours, conduct rounds every 45 minutes, and change incontinence products regularly, documenting each change. R1 was not left soiled. Staff stated that W1 visits around 7:00 a.m., and closes the door of R1s room. Staff stated that W1 can call staff anytime R1 needs cleaning or changing. Housekeeping addressed W1’s ant report cleaned and treated the area. The memory care unit was odor-free, and staff responded to hygiene needs.

Based on document review, the facility is non-medical. Hospice care and a home health aide were ordered by R1’s medical providers focusing on comfort care. Due to declining health. R1 was transferred from Assisted Living to the Memory Care unit for a higher level of care.

On 12/04/25, LPA conducted a second inspection of the memory care unit, including rooms #1, 5, 9, and 10, bathrooms, shower areas, walls, floors, storage, and beds. No foul odor was detected. The exterior perimeter was clear of ants and trash. The kitchen was sanitary and organized, with no ants observed on counters, floors, or cabinets. Based on maintenance records the facility has a contract with Banner Pest Services. The company conducts fumigation each month as a preventive measure or extra services if needed.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations(s) did or did not occur, therefore the allegations are unsubstantiated.

No deficiencies were cited during today's visit based on CCR Title 22. An exit interview was conducted with ADM/GM Ida Gemignani-Stearns. A copy of the report was provided.

page 3 of 3 end of report

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Maria Partoza
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2026

LIC9099 (FAS) - (06/04)

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