Merrill Gardens at Monterey

Type of visit: Case Management - Incident

On 7/06/2026, Licensing Program Analyst (LPA) V Gorban conducted an unannounced Case Management visit regarding a self reported medication error that was received in Fresno Regional Office (RO) on 6/25/2026. During this visit LPA met with facility administrator Jule May Estrelado. Per incident report received in Fresno Regional Office on 06/25/26, a medication error occurred on 06/25/2026, staff 1 (S1) administered medication twice, 6AM and 9AM to resident (R1) which was prescribed as PRN. R1 was administered PRN Motrin of 200 mg. Documentation provided during case management visit documents, R1's physician was notified via email on 06/25/2026 of medication error. Staff resigned on 06/30/2026 . Staff involved (S1) received additional medication training. Deficiency cited on the attached 809-D in accordance with the California Code of Regulations (CCR), Title 22, Division 6, Chapter 8. Exit interview conducted. A copy of report and appeal rights provided to Administrator.the state’s words, verbatim · CDSS document, Jul 6, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(c)(2) · Plan of correction due date: Jul 17, 2026

Incidental Medical and Dental Care. (2) Once ordered by the physician the medication is given according to the physician's directions.. Thisnrequirement sas not observe das evidenced by: The facility failed to ensure medications provided to residents as prescribed. R1 was provided dose of PRN med twice, which poses potential health and safety risk to persons in carethe state’s words, verbatim · CDSS document, Jul 6, 2026

Plan of correction: The facility administrator will provide PLAN of correction to LPA by email by POC due date following title 22 REGULATIONS. Deficiency was corrected during the visit.

Type of visit: Required - 1 Year

On 05/18/2026, Licensing Program Analyst (LPA) V Gorban arrived at the facility unannounced to conduct Required Annual Inspection. LPA met with Administrator (AD) Julie Estrelado, certification number 6052504740 and expiration date 6/13/2025. LPA conducted tour inside and out of facility with AD. Residents observed at the facility during lunch time. The facility, kitchen observed with walk in freezer , temperature recorded at -3 degrees F, and refrigerator with 38 degrees F. Facility receive food by Cisco twice a week on Mondays and Thursdays. An adequate supply of perishable and non-perishable food was observed to be properly stored in freezer, refrigerator, and pantry. Residents occupy all three stories of the building : back part of the main floor / section occupied by memory care residents with census of 17 residents during the visit. Assisted living takes most of the building; all three levels. Dinning room, kitchen, common area and theater located on the main level. The facility has a barber shop and pool on the lower level. Pool and barber shop locked and accessible only when requested. Only staff has access keys to either rooms. Both rooms posted schedule when open and staff present during open hours. LPA toured resident rooms that were observed to be at a comfortable temperature of 74 degrees, clean, in good repair, and no passageway obstructions or fire hazards observed. Rooms and observed with adequately furnished with bed, dresser, and adequate lighting. Hot water temperature tested at 108 degrees F. LPA observed securely fastened grab bar and non-skid floor mats with floor non-slip lining in shower area. Fire extinguisher was observed with a service date of 01/28/2026. Last Fire drill date recorded on April 15, 2026. Report continues on attached LIC809-C Medications were stored in a locked in both medication rooms: memory care and assisted living. Medications records were reviewed. First Aid Kit was stored in medication room and observed with all required items. LPA toured laundry room and observed chemicals were stored and locked for staff use only. Facility courtyard was toured and observed to be free from debris. There was outdoor seating available for the residents. A count of residents’ and staff files were reviewed to have updated required information. Community Care Licensing (CCL) is always striving to have facility files that reflect the most accurate & up to date information for your facility. In an effort to maintain your facility file, please submit the most current & complete forms &/or information as identified below: Residential Care Facility for the Elderly (RCFE): · LIC 308 Designation of Facility Responsibility · LIC 309 Administrative Organization Please submit the above forms/information to Fresno CCL by: 05/25/2026 As an operator of a Community Care Licensed facility it is your responsibility to be aware of and in compliance with all regulations, including Chaptered Legislation. Go to www.ccld.ca.gov to stay updated and informed. An exit interview was conducted with the ED. Issues deficiencies attached on LIC809-D A copy of this report was given to the AD, whose signature on this form confirm receipt of these reports.the state’s words, verbatim · CDSS document, May 18, 2026

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Vadim Gorban conducted an unannounced visit today to conduct a case management visit. LPA Gorban met with Administrator Julie May Estrellado, and explained the purpose of the visit. During this visit LPA toured the facility and observed residents in care. The facility reported resident (R1) fall that took place on 2/5/2026. Staff responded to the call light, observed R1 on the floor. Resident was taken out of the facility for medical evaluation. Per administrator, Imaging diagnostic revealed no trauma. LPA requested facility files for review. No deficiency cited during this visit. Exit interview conducted with Administrator Julie Estrellado, report signed and copy of this report provided for facility records.the state’s words, verbatim · CDSS document, Feb 11, 2026

Type of visit: Required - 1 Year

On 05/21/2025, Licensing Program Analyst (LPA) V Gorban arrived at the facility unannounced to conduct Required Annual Inspection. LPA met with Administrator (AD) Tiffaney Santoro, certification number 6052504740 and expiration date 6/13/2025. LPA conducted tour inside and out of facility with AD. Residents observed at the facility during lunch time. The facility, four story building: ground floor occupied by memory care residents. First floor includes dinning room, common area and theater. Second and third floors are occupied by resident rooms. LPA toured resident rooms that were observed to be at a comfortable temperature of 74 degrees, clean, in good repair, and no passageway obstructions or fire hazards observed. Rooms and observed with adequately furnished with bed, dresser, and adequate lighting. Hot water temperature tested at 112 degrees F. LPA observed securely fastened grab bar and non-skid floor linings attached in shower area. Fire extinguisher was observed with a service date of 01/02/2025. Last Fire drill date recorded on April 16th, 2025 Dining area and Kitchen were toured. An adequate supply of perishable and non-perishable food was observed to be properly stored in freezer, refrigerator, and pantry. Food is delivered by Cisco twice a week. Refrigerator temperature was maintained at 35-degree F. and freezer was maintained at 0-degree F. Medications were stored in a locked medication room. Medications records were reviewed. First Aid Kit was stored in medication room and observed with all required items. LPA toured laundry room and observed chemicals were stored and locked for staff use only. Report continues on attached LIC809-C Facility courtyard was toured and observed to be free from debris. There was outdoor seating available for the residents. A count of residents’ and staff files were reviewed to have updated required information. Community Care Licensing (CCL) is always striving to have facility files that reflect the most accurate & up to date information for your facility. In an effort to maintain your facility file, please submit the most current & complete forms &/or information as identified below: Residential Care Facility for the Elderly (RCFE): · LIC 308 Designation of Facility Responsibility · LIC 309 Administrative Organization · LIC 500 Personnel Report · LIC 610E Emergency Disaster Plan For Residential Care Facilities For The Elderly · LIC 9020 Register of Facility Clients/Residents Please submit the above forms/information to Fresno CCL by: 05/25/2025 As an operator of a Community Care Licensed facility it is your responsibility to be aware of and in compliance with all regulations, including Chaptered Legislation. Go to www.ccld.ca.gov to stay updated and informed. No deficiencies issued during this inspection. An exit interview was conducted with the ED. A copy of this report was given to the AD, whose signature on this form confirm receipt of these reports.the state’s words, verbatim · CDSS document, May 21, 2025

Allegation investigated: Unqualified staff left in charge of residents Staff did not properly assess resident Staff are not checking on resident Staff are not providing adequate food service to residents Staff are not ensuring residents have activities Staff are not ensuring resident's room is kept clean Staff are not reminding resident about appointments Staff are not ensuring resident was given a shower Staff are not ensuring resident's dog was taken care of Staff are not meeting residents needs

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced facility visit to deliver findings on the allegations listed above . LPA met with facility Senior Executive chef Jaime Rios, and explained the purpose of today's visit. Regarding the allegation Unqualified staff left in charge of residents. Staff 1 is quailfied to be in charge when Administrator is not present at the facility. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. Unsubstantiated Regarding the allegation Staff did not properly assess resident. Resident 1 was assessed on 01/23/2024, and again on 05/15/2024. Resident 1 signed both assessments acknowledging they reviewed and agree to pay level of care fees. Resident 2 was assessed upon admission to this facility, on 03/14/24, and 05/02/24. Resident 2's assessments were all signed by the Responsible party. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. Regarding the allegation Staff are not checking on resident. Resident 2 stated facility staff checks on them several times daily. LPA Hurt interviewed 4 facility residents who all stated the staff is kind and checks on them often. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. Regarding the allegation Staff are not providing adequate food service to residents. Resident 1 stated the facility does provide an adequate amount of food. LPA Hurt interviewed 4 facility residents who all stated the facility food is good and there are lots of other options if they don't like the daily main course. LPA reviewed menus in residents bedrooms and posted throughout the facility. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. Regarding the allegation Staff are not ensuring residents have activities. Resident 2 stated the facility does provide activities but they chose not to participate in most of them. Executive Director documents resident 2 was offered to attend activities on several occasions and declined. LPA Hurt interviewed 4 facility residents who all stated the facility provides plenty of activities including exercise, movies, swim, card games, and music. LPA Hurt observed several activity calendars posted throughout the facility. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. Regarding the allegation Staff are not ensuring resident's room is kept clean. Resident 2 stated their room is cleaned twice weekly. LPA observed Resident 2's room appeared to be clean and tidy. LPA Hurt interviewed four facility residents who all stated their room is cleaned once or twice weekly and they are happy with the housekeeping services provided. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. Regarding the allegation Staff are not reminding resident about appointments. Resident 2 stated they do not have many appointments and they are taken to appointments by their daughter. LPA interviewed 4 facility residents who all stated they make their own appointments and are taken to appointments either by family, private caregiver or facility staff. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. Regarding the allegation Staff are not ensuring resident was given a shower. Resident 2 stated they are showered when a shower is requested. LPA reviewed several "Shower refusal" forms signed by Resident 2 documenting they did often decline showers. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. Regarding the allegation Staff are not ensuring resident's dog was taken care of. Facility staff is not responsible for ensuring resident pets are cared for. Resident 1 stated his pet was difficult to care for and was eventually taken to the local SPCA, and adopted into a good home. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. Regarding the allegation Staff are not meeting residents needs. Resident 2 stated the facility staff cleans their room, the facility has activities, the facility food is ok, the facility staff assists with showers as needed, and the staff is very friendly. LPA Hurt interviewed 4 facility residents who all stated the facility has activities, food, and friendly staff. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. Exit interview conducted with Jaime Rios, and a copy of this report along with appeals rights provided.the state’s words, verbatim · CDSS document, Dec 14, 2024 · control 24-AS-20240531111520

Allegation investigated: Staff does not ensure elevator is in good repair Staff does not ensure special food service is served with accuracy for residents in care

Licensing Program Analyst (LPA) Sarah Hurt arrived at the facility unannounced on July 27,2024 at 1:00 p.m. to investigate the above allegation. LPA met with Executive Chef Jaime Rios ,and explained the purpose for today’s visit. Regarding the allegation Staff does not ensure elevator is in good repair. Facility Administrator stated there was an issue where one of the facility elevators was not working for a period of time, but there is always another elevator available for residents. During the time when the elevator was not working facility staff offered free food delivery to residents rooms, and assistance with getting to the second elevator for any residents that need assistance. Facility Administrator stated the elevator is currently repaired and working. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. Unsubstantiated Continued... Regarding the allegation Staff does not ensure special food service is served with accuracy for residents in care. Reporting Party stated the food service delivery provided when the facility elevator was not working went really well with no issues. Reporting party stated the food service was prompt, and everything ordered was provided. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. No deficiencies cited today Per Title 22 Regulations. Exit interview conducted with facility Jaime Rios, and copy of report provided.the state’s words, verbatim · CDSS document, Jul 27, 2024 · control 24-AS-20240429082716

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced visit today to conduct a Case Management visit. LPA Hurt met with Administrator Tiffaney Santoro, and explained the purpose of the visit. The facility reported a medication error that took place on 07/11/2024 at 01:15 p.m. Staff 1 handed Resident 1 a medication that was meant for another resident. Resident 1 was hospitalized due to the medication error, and returned to the community around 02:00 a.m. on 07/12/2024. Staff 1 has since been provided training and removed from the medication technician in training position. The following Deficiencies are being cited per Title 22 Regulations. Exit interview conducted with Administrator Tiffaney Santoro, a copy of this report along with appeal rights provided.the state’s words, verbatim · CDSS document, Jul 17, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a) · Plan of correction due date: Jul 18, 2024

87465 Incidental Medical and Dental Care (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: (4) The licensee shall assist residents with self-administered medications as needed. (5) Facility staff, except those authorized by law, shall not administer injections, but staff designated by the licensee may assist persons with self-administration as needed. Assistance with self-administered medications shall be limited to the following: The following requirement has not been met as evidenced by: Resident 1 was given incorrect medication on 07/11/2024 resulting in a visit to the hosptial, which poses an immediate health,safety, or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jul 17, 2024

Plan of correction: Administrator will send training on medication administration for Staff 1, and a statement acknowledging removal of staff 1 from medication technication in training position to LPA by 07/18/24 POC date.

Type of visit: Required - 1 Year

On 5/28/2024, Licensing Program Analyst (LPA) D. Ayers arrived unannounced to conduct a Required Annual Inspection. LPA met with Executive Director Tiffaney Santoro and announced the purpose of the visit. Administrator Certificate is current with renewal date 6/13/2025. LPA toured the facility inside and outside. All passageways and exits were clear and free from obstruction. Fire extinguishers had service tags dated within the last year, and the facility sprinkler system had been serviced. Facility staff maintain records of emergency drills, which are conducted monthly. LPA observed a sufficient supply of emergency food and water, which was properly stored. LPA toured the facility kitchen. Kitchen was clean and LPA observed a sufficient supply of perishable and nonperishable foodstuffs, which were stored properly. Common areas were clean, odor-free, and well-lit. Interior and exterior doors to facility pool area were securely locked. Outdoor areas were free from hazards and provided adequate seating for residents. LPA toured resident bedrooms and bathrooms. Bedrooms were clean and free from odor. Bathrooms were clean, contained secure grab-bars and non-skid mats, and fixtures were functioning properly. LPA reviewed facility emergency disaster plan. LPA reviewed a sample of staff and resident files. While reviewing resident files, at approximately 1:50pm, LPA observed that two residents, both diagnosed with dementia, did not have an annual medical assessment and reappraisal completed as required by Title 22 regulations. See attached LIC 809-D deficiencies cited in accordance with California Code of Regulations Title 22, Division 6. Administrator was provided with a copy of the report and appeal rights.the state’s words, verbatim · CDSS document, May 28, 2024

Allegation investigated: Resident was trapped in the elevator due to facility not obtaining back-up power.

On 3/7/2024, Licensing Program Analyst(LPA) D. Ayers arrived at the facility unannounced to conduct an initial 10-day complaint inspection. LPA met with Senior Business Office Director Amor Sorius and announced the purpose of the inspection. During the visit, LPA conducted interviews, obtained records, and conducted a tour of the facility. Allegation - Resident was trapped in the elevator due to facility not obtaining back-up power. Based on records review, observations, and interviews, facility staff have prepared a comprehensive emergency disaster plan. On 2/4/2024, a resident could not exit the elevator for approximately two hours due to a power outage. The elevator was opened by emergency responders. Facility elevator has been properly serviced and maintained. No resident was injured during the power outage. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted, and a copy of the report was provided via email. Unsubstantiatedthe state’s words, verbatim · CDSS document, Mar 7, 2024 · control 24-AS-20240228154207

Allegation investigated: Facility staff are not assisting residents with activities of daily living Facility staff are not meeting the needs of residents in care

On 1/4/2023, Licensing Program Analyst (LPA) D. Ayers conducted an unannounced complaint inspection. LPA met with Executive Director Tiffaney Santoro announced the purpose of the inspection. The purpose of this visit is to deliver the finding of the investigation completed by the Department. During the course of the investigation, the department inspected the facility, conducted interviews, and reviewed records. The following allegations have been determined to be Substantiated. 1. Facility staff are not assisting residents with activities of daily living: Based off of interviews, facility staff have stated that they were advised by facility administration that they are not required to assist residents with eating. Responsible parties for residents in care and other witnesses have been told by facility staff that the facility does not assist residents with feeding, and that California Code of Regulations Title 22 does not require or allow Residential Care Facilties for the Elderly(RCFE) to assist residents with eating. Substantiated 2. Facility staff are not meeting the needs of residents in care: based off of records reviewed, although facility residents have been assessed by facility staff as needing assistance with dining services, which includes assistance eating, facility staff are not always providing such assistance. Based observations, records reviewed, and interviews, the preponderance of evidence standard has been met; therefore, the above allegations are found to be substantiated at this time. Per the California Code of Regulations (CCR), Title 22, Division 6, Chapter 8, the following deficiencies were observed and cited on the attached LIC 9099-D. Failure to correct the deficiency may result in civil penalties. An exit interview was conducted, and a copy of this report provided to the licensee via email. Appeal Rights (LIC 9058) were provided to the licensee.the state’s words, verbatim · CDSS document, Jan 4, 2024 · control 24-AS-20231115122107

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87464(f)(4) · Plan of correction due date: Jan 12, 2024

87464 Basic Services: (f)(4) Personal assistance and care as needed by the resident and as indicated in the pre-admission appraisal, with those activities of daily living such as dressing, eating, bathing and assistance with taking prescribed medications...This requirement was not met as evidenced by Based on interviews and records review, the licensee failed to ensure that at least one out of 114 residents was provide necessary assistance with activities of daily living, which presents a risk to the health and safety of residents in care.the state’s words, verbatim · CDSS document, Jan 4, 2024

Plan of correction: Executive Director agreed to provide staff training on Title 22 requirements for assistance with activities of daily living.

Type of visit: Case Management - Deficiencies

On 1/4/2024, Licensing Program Analyst(LPA) D. Ayers arrived unannounced to deliver complaint findings and conduct a case management inspection. LPA met with Executive Director Tiffaney Santoro and announced the purpose of the inspection. The purpose of this inspection was to address deficiencies which were observed during the investigation of a complaint made against the facility, complaint control number 24-AS-20231115122107, received 11/15/2023. It was discovered that facility staff conducted a reappraisal on 11/19/2023, due to a change in a resident's condition, which did not include the responsible party of the resident. See California Code of Regulations Title 22, Division 6, Chapter 8, Article 8, Section 87463 Reappraisals. It was also discovered that, after a rate increase due to a change in the level of care of a resident, facility staff did not provide appropriate written notice of this increase in fees to the resident's representative within two business days of providing services at the new level of care. See Health and Safety Code, Chapter 3.2, Article 6, 1569.657. See attached LIC809D for deficiencies cited in accordance with California Code of Regulations and Health and Safety Code. Failure to correct these deficiencies could result in Civil Penalty. Exit interview conducted. A copy of this report and Appeal Rights were provided to the licensee.the state’s words, verbatim · CDSS document, Jan 4, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87463(c) · Plan of correction due date: Jan 12, 2024

87463 Reappraisals: (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...This requirement was not met as evidenced by: Based on record review and interview, the licensee failed to meet this requirement by conducting at least one reappraisal which did not include the responsible party for the resident being appraised. This presents a potential risk to the health and safety of residents in care.the state’s words, verbatim · CDSS document, Jan 4, 2024

Plan of correction: Executive Director agreed to conduct refresher training for herself and appropriate staff on Title 22 requirements for reappraisals.

From the deficiency page — Deficiency type: Type B · Section cited: HSC1569.657 · Plan of correction due date: Jan 12, 2024

§1569.657 (a) For any rate increase due to a change in the level of care of the resident, the licensee shall provide the resident and the resident’s representative...written notice of the rate increase within two business days after initially providing services at the new level of care. This requirement was not met as evidenced by: Based on interview and records review, the licensee failed to meet this requirement for at least one resident and their responsible party, by not providing written notice within two business days of raising fees due to a change in the level of care.the state’s words, verbatim · CDSS document, Jan 4, 2024

Plan of correction: Executive Director agreed to provide a sample written notice for a rate increase to CCLD by POC due date, as well as conduct staff training on requirement set forth in Health and Safety Code 1569.657.