MERRILL GARDENS AT GILROY

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)(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 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 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

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

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

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.