MERRILL GARDENS AT GILROY

Official classification

Type B

Official code

87507(f)

Regulation authority

CCR

What the official deficiency says

(f) The licensee shall comply with all applicable terms and conditions set forth in the admission agreement, including all modifications and attachments. This requirement is not met as evidenced by: Based on interview, record review and observation the licensee did not comply with the section cited above wherein the licensee did not comply with the terms and conditions set forth in resident (R1)’s admission agreement by not ensuring R1 was credited assisted living care services costs per the admission agreement timeframe which poses a potential health, safety, and personal rights risk to persons in care.

Official plan of correction

On 07/17/2025, the GM and VP of Operations credited back R1’s assisted living care services costs and submitted the ledger to LPA Kabariti showing the care cost was credited back. Deficiency cleared during visit.

Deadline recorded: Oct 2, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. … This requirement is not met as evidenced by: Based on interview and record review, the licensee did not ensure that staff were competent to assist residents with medication administration in 2 counts wherein 2 resident’s were administered another resident’s medication on 02/25/25 and 07/17/25 which poses an immediate health, safety, and personal rights risk to persons in care.

Official plan of correction

Licensee immediately removed the MedTechs who were part of the medication errors and the staff were required to re-complete medication training. Licensee will also provide in-service training to MedTech trainers regarding medication pass oversight. Licensee will submit the in-service training document to LPA Kabariti via email by POC due date of 07/18/2025.

Deadline recorded: Jul 18, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a) ... the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, ... and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage.This requirement is not met as evidenced by: Based on record review, interview and observation the licensee did not ensure to keep toxic items inaccessible to resident (R1) who is diagnosed with dementia and should not have access to cleaning solutions and toxins per the physician, which posed an immediate health, safety, and personal rights risk to persons in care.

Official plan of correction

Licensee immediately removed the toxic items from resident (R1)'s room. Licensee will submit an in-service training for all staff regarding appropirate chemical safety for residents with dementia. Licensee will submit the in-service training document to LPA Kabariti via email by POC due date.

Deadline recorded: Feb 21, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(8)

Regulation authority

CCR

What the official deficiency says

(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (8) To have their representatives regularly informed by the licensee of activities related to care or services, including ongoing evaluations, as appropriate to their needs. This requirement is not met as evidenced by: Based on interview, record review and observation the licensee did ensure to comply with the section cited above by not informing R1 and R1’s authorized representatives of the need to remove R1’s medications from his/her room prior to removing the medications, despite R1’s care plan not requiring medication management which poses an immediate health, safety and personal rights risk to persons in care.

Official plan of correction

Licensee will provide an in-service training with staff regarding the appropriate steps for when a resident is determined to need medication management, to include proper communication with the resident and resident's authorized representatives. Licensee will submit the in-service training document to LPA Dolores via email by POC due date of 12/20/2024.

Deadline recorded: Dec 20, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

(a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, … (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement is not met as evidenced by: Based on interview and record review, the licensee did not ensure there was enough staff scheduled in prom and plaza during the NOC shift in May 2024 and did not ensure staff responded to the resident’s call buttons within 15 minutes, which poses an immediate health, safety and personal rights risk to persons in care.

Official plan of correction

Licensee is currently scheduling 2 caregivers for Prom and Plaza during the NOC shift, which is the facility's standard ratio for NOC. Licensee will submit the staffing schedule for the NOC shift which shows their standard staffing ratio. Licensee will also provide an in-service training to staff regarding timely pendant call response times. Licensee will submit the in-service training to LPA Dolores via email by POC due date on 12/20/2024.

Deadline recorded: Dec 20, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(3)

Regulation authority

CCR

What the official deficiency says

(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature,... This requirement is not met as evidenced by: Based on interview, record review and observation S1's aggressive actions towards R1, the night of 12/02/2024 violated R1's personal rights, which poses/posed an immediate health, safety, and personal rights risk to persons in care.

Official plan of correction

Licensee terminated S1 on 12/4/2024. Licensee conducted an in-service training after the incident on 12/4/24 and 12/5/24 to include topics of understanding the importance of “see something say something”; mandated reporters; the steps to take to ensure residents safety and well-being; and understanding resident rights. Deficiency was cleared during visit.

Deadline recorded: Dec 11, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87463(a)(3)

Regulation authority

CCR

What the official deficiency says

(a) The pre-admission appraisal shall be updated, in writing as frequently as necessary to note significant changes and to keep the appraisal accurate. The reappraisals shall document changes in the resident's physical, medical, mental, and social condition. Significant changes shall include but not be limited to: (3) Any illness, injury, trauma, or change in the health care needs of the resident that results in a circumstance or condition specified in Sections 87455(c) … This requirement is not met as evidenced by: Based on interview, record review, and observation the licensee did not comply with the section cited above wherein the facility did not reassess R1 after 11/30/2023, even though R1 continued to be a fall risk and had multiple falls resulting in injuries after 11/30/2023 which poses an immediate health, safety and personal rights risk to persons in care.

Official plan of correction

Licensee states they will reassess residents upon a change of condition immediately. Licensee will submit a statement of understanding of the section cited and the plan going forward, to LPA Dolores via email by POC due date (12/07/24).

Deadline recorded: Dec 7, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

(a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement is not met as evidenced by: Based on interview, record review and observation the licensee did not comply with the section cited wherein R1's alert button was not responded to on 7 different occasions and based on LPA Dolores observation on 10/18/23 which poses an immediate health, safety, and personal rights risk to persons in care.

Official plan of correction

Licensee will conduct a staff training regarding responding to call buttons in Garden House (aka Memory Care). Licensee will submit the training document to LPA Dolores via email by POC due date.

Deadline recorded: Oct 30, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(a)(1)

Regulation authority

CCR

What the official deficiency says

(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: (1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. This requirement was not met as evidenced by: Based on record review and observation, the licensee did not ensure to obtain an updated physician’s report for resident (R1) after staff observed changes in R1’s conditions based on the re-evaluations and updated service plans, and did not obtain follow-up with R1's physician in a timely manner for an order for R1's nutritional beverage which poses a potential health, safety and personal rights risk to persons in care.

Official plan of correction

Licensee will be implementing a high-risk meeting weekly with the leadership team to ensure processes are being followed. Licensee will submit a statement of understanding of the section (87465(a)(1)) to LPA Dolores via email by POC due date of 10/14/2024.

Deadline recorded: Oct 14, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87463(c)

Regulation authority

CCR

What the official deficiency says

(c) The licensee shall arrange a meeting with the resident, the resident’s representative, if any, appropriate facility staff, and a representative of the resident’s home health agency, if any, when there is significant change in the resident’s condition, or once every 12 months, whichever occurs first, as specified in Section 87467, Resident Participation in Decision Making. This requirement was not met as evidenced by: Based on record review and observation, the licensee did not ensure to review R1’s updated service plans with R1’s responsible party which poses a potential health, safety and personal rights risk to persons in care.

Official plan of correction

Licensee will submit a written plan of the facility's process in ensuring the needs and services plans are reviewed and signed with the resident and/or their responsible parties. Licensee will send the written plan via email by POC due date of 10/14/2024.

Deadline recorded: Oct 14, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87563(b)

Regulation authority

CCR

What the official deficiency says

(b) The licensee shall immediately bring any such changes to the attention of the resident's physician and his family or responsible person. This requirement was not met as evidenced by: Based on record review and observation, the licensee did not ensure to report R1’s falls to R1’s physician on 04/30/2022, 06/24/2022, 07/05/2022, 07/06/2022, 08/09/2022, 09/23/2022, 10/07/2022 which poses a potential health, safety and personal rights risk to persons in care.

Official plan of correction

Licensee will conduct a internal audit to ensure resident's physician's are being notified of any changes of conditions and to review the facility's process in ensuring physician's are being notified of any changes of conditions. Licensee will submit a written result of the internal audit to LPA Dolores via email by POC due date on 10/14/2024.

Deadline recorded: Oct 14, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

(a) The pre-admission appraisal shall be updated, in writing as frequently as necessary to note significant changes and to keep the appraisal accurate. The reappraisals shall document changes in the resident's physical, medical, mental, and social condition. Significant changes shall include but not be limited to: This requirement was not met as evidenced by: Based on record review and observation, the licensee did not ensure resident (R1) was re-evaluated and R1’s service plans were updated after falls resulting in the resident sustaining injuries due to the falls which poses an immediate health, safety, and personal rights risk to persons in care.

Official plan of correction

Licensee will submit a statement of understanding of the section cited (87463(a)) to LPA Dolores via email by POC due date of 10/08/2024.

Deadline recorded: Oct 8, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87412(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: This requirement is not met as evidenced by: This requirement is not met as evidenced by: Deficient Practice Statement Based on record review and observation, licensee did ensure staff (S1) and (S4) health screening and TB result was not on file which poses a potential health, safety and personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/26/2024 Plan of Correction Licensee will submit a plan of correction to ensure (S1) and (S4) obtain health screening and TB result via email to LPA Tarin by POC due date 9/26/2024.

Official classification

Type A

Official code

87468.1(a)(3)

Regulation authority

CCR

What the official deficiency says

(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. This requirement is not met as evidenced by: Based on interview and record review, the licensee did not ensure resident (R1) was free from abuse by staff (S1) who handled R1 roughly on the night of 06/13/2022 which poses an immediate, health, safety and personal rights risk to persons in care.

Official plan of correction

Licensee will conduct an in-service training on the section cited. Licensee will submit the in-service training record to LPA Dolores via email by POC due date of 09/20/2024.

Deadline recorded: Sep 20, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

Not listed

Regulation authority

Not listed

What the official deficiency says

(b) The licensee shall immediately bring any such changes to the attention of the resident's physician and his family or responsible person. This requirement is not met as evidenced by: Based on interview and record review, the licensee did not ensure to immediately bring to the attention of resident (R1)’s family or responsible party of R1’s shoulder pain which poses an immediate health, safety and personal rights risks to persons in care.

Official plan of correction

Licensee will conduct an in-service training on the section cited. Licensee will submit the in-service training record to LPA Dolores via email by POC due date of 09/20/2024.

Deadline recorded: Sep 20, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87405(d)(2)

Regulation authority

CCR

What the official deficiency says

(d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply. (2) Knowledge of and ability to conform to the applicable laws, rules and regulations. This requirement is not met as evidenced by: Based on interview, record review, and observation the Administrator failed to exhibit the knowledge of applicable laws, rules and regulations resulting in serious violations which poses an immediate health safety and personal rights risk to persons in care.

Official plan of correction

Licensee will ensure that immediately, Administrator will be trained regarding Administrator Qualification, Duties and Responsibilities. Temporary Administrator is in place. Deficiency was corrected.

Deadline recorded: Jun 14, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(1)

Regulation authority

CCR

What the official deficiency says

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or This requirement is not met as evidenced by: Based on interview and record review the licensee did not obtain a criminal record clearance for staff (S1) prior to S1 starting work which poses an immediate health, safety, and personal rights risk to persons in care.

Official plan of correction

Licensee will submit a written plan regarding the section cited to LPA Dolores via email by POC due date.

Deadline recorded: Jun 13, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87211(a)(2)

Regulation authority

CCR

What the official deficiency says

(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (2) Occurrences, such as epidemic outbreaks, poisonings, catastrophes or major accidents which threaten the welfare, safety or health of residents, personnel or visitors, shall be reported within 24 hours either by telephone or facsimile to the licensing agency and to the local health officer when appropriate. This requirement is not met as evidenced by: Based on interview, record review, and observation the licensee did not ensure to report the resident (R1)'s death and incident to the department within 24 hours which poses / posed an immediate health, safety, and personal rights risk to persons in care.

Official plan of correction

Licensee will submit the training documentation to LPA Dolores via email by POC due date.

Deadline recorded: May 30, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87466

Regulation authority

CCR

What the official deficiency says

The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. When changes such as unusual weight gains or losses or deterioration of mental ability or a physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement is not met as evidence by: Based on interview, record review, and observation the licensee did not ensure resident (R1) was checked on regularly for 72 hours after being discharged back to the facility from the hospital. On 08/27/2023, resident was found on the floor with injuries to include a golf size bump on the forehead and skin discoloration on the eye, elbow, hands and knees. This poses/posed an immediate health, safety, and personal rights risk to persons in care.

Official plan of correction

Licensee will provide an in-service training for all staff to include the topic of observations and documenting resident's conditions and monitoring resident's for 72 hour checks. Licensee will submit the training documentation to LPA by POC due date of 01/17/2024. Licensee will also submit a plan to provide an all-staff training for the remainder of the staff who are not present today. Licensee will submit the plan to LPA by POC due date.

Deadline recorded: Jan 17, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidence by: Based on interview, record review, and observation the licensee did not ensure resident (R1) was accorded a healthful and comfortable accommodation due to being found on the floor with ants on R1’s body which poses/posed an immediate health, safety, and personal rights risk to persons in care.

Official plan of correction

Licensee will provide an in-service training on topics to inlcude sanitation, cleanliness, and resident's health and safety. Licensee will submit the in-service training to LPA by POC due date of 01/17/2024. Licensee will submit the facility's pest control contract to include any documentation on the ants issue. Licensee will submit the documentation to LPA by POC due date.

Deadline recorded: Jan 17, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87463(a)(3)

Regulation authority

CCR

What the official deficiency says

(a) The pre-admission appraisal shall be updated, in writing as frequently as necessary to note significant changes and to keep the appraisal accurate. The reappraisals shall document changes in the resident's physical, medical, mental, and social condition. Significant changes shall include but not be limited to: (3) Any illness, injury, trauma, or change in the health care needs of the resident that results in a circumstance or … This requirement is not met as evidenced by: Based on interview, record review, and observation the licensee did not ensure resident (R1)’s reappraisal was accurate and documented R1’s diagnosis and changes to the resident’s condition after returning to the facility from the hospital on 08/19/2023 which poses/posed an immediate health, safety, and personal rights risk to persons in care.

Official plan of correction

Licensee will provide an in-service training with the facility's directors, team nurses, and care staff to go over re-appraisals when the resident returns to the community. Licensee will submit the in-service training to LPA by POC due date of 01/17/2024.

Deadline recorded: Jan 17, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c) or. This requirement was not met as evidenced by: Based on record review, interview, and observation the Licensee did not comply with the section cited above by not requesting a transfer to associate S1 and S2 to the facility prior to individuals starting work, which poses an immediate health, safety, and personal rights risk to persons in care.

Official plan of correction

Staff (S1) and (S2) are no longer employees at the facility. Licensee will ensure all new and current staff are fingerprint cleared and associated to the facility. Licensee will submit a plan in writing to ensure all new staff are associated to the facility prior to starting work. Licensee will also submit a plan in writing to audit their facility roster to ensure all current staff are fingerprint cleared and associated to the facility. Licensee will review section 87355 and send a statement of understand of the section and send the facility’s plan to LPA by POC due date via email.

Deadline recorded: Feb 1, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(3)

Regulation authority

CCR

What the official deficiency says

(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature ... This requirement is not met as evidenced by: Based on interview and observation of the fall detection video, it was evident that after S1 and S2 failed to assist R1 back onto the wheelchair after a fall, S1 kneed R1 on the left side causing R1 to budge, which poses an immediate health, safety, and personal rights risk to persons in care.

Official plan of correction

The Licensee has completed staff training on personal rights after the incident. Licensee has conducted a town hall meeting and all-staff meeting regarding resident rights and the responsibilities of a mandated reporter. Licensee will also provide an in-service training to all staff on the proper ways to assist a resident after a fall. Licensee will submit the training documents and meeting agenda to LPA by POC due date via email.

Deadline recorded: Feb 1, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(1)

Regulation authority

CCR

What the official deficiency says

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or ... This requirement was not met as evidenced by: Based on record review, interview, and observation the Licensee did not comply with the section cited above for staff (S1) which poses an immediate health, safety, and personal rights risk to persons in care.

Official plan of correction

Staff (S1) was immediately dismissed from work and will not return until a fingerprint clearance has been obtained. Licensee agreed to submit a plan in writing to ensure all new staff are fingerprint cleared and associated to the facility. Licensee will submit POC to LPA via email by POC due date.

Deadline recorded: Dec 9, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c) or ... This requirement was not met as evidenced by: Based on record review, interview, and observation the Licensee did not comply with the section cited above for staff (S2) which poses an immediate health, safety, and personal rights risk to persons in care.

Official plan of correction

Licensee agreed to submit a plan in writing to ensure all new staff are fingerprint cleared and associated to the facility. Licensee will ensure to send necessary paperworks to the Department by end of day. Licensee will submit POC to LPA via email by POC due date.

Deadline recorded: Dec 9, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705

Regulation authority

CCR

What the official deficiency says

(f) The following shall be stored inaccessible to residents with dementia: (2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview, the licensee did not comply with the section cited above by having multiple sharp gardening tools and toxins accessible in the commuity garden to persons with dementia which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/20/2022 Plan of Correction Licensee immediately secured all the sharp gardening tools and toxins during visit. Licensee states to implement a locked storage for all gardening supplies going forward. Licensee will review section 87705 and submit a statement of understanding of the section to LPA by POC due date.