Merrill Gardens at Rancho Cucamonga

Allegation investigated: Facility is operating without a qualified administrator.

Licensing Program Analysts (LPA) Mary Rico conducted an unannounced visit to investigate and deliver findings for the above allegation. LPA met with Administrator Usman Chaudary and explained the reason for the visit. For the allegation, Facility is operating without a qualified administrator. During today’s visit, LPA interviewed Administrator, conducted a record review and obtain copies. During interview with Administrator, Administrator confirm they have been the Administrator since June 26th 2023. During record review LPA verified facility is operating with a qualified Administrator. Based on the information found during the investigation, the allegation listed above is deemed UNFOUNDED. A finding that the complaint is UNFOUNDED means that the allegation was without a reasonable basis. Therefore, the above allegation is dismissed. Unfoundedthe state’s words, verbatim · CDSS document, Sep 14, 2023 · control 56-AS-20230913160315

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Allegation investigated: Facility is unsanitary Residents are not provided proper assistance by facility staff Residents in care are not provided proper bedding

Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Administrator Usman Chaudary and explained the purpose of the visit. The investigation consisted of staff interviews, resident interviews, document reviews, and facility tour. For allegation, Facility is unsanitary. During interview with Administrator, Administrator informed LPA facility has five (5) Housekeeping/Universal workers that provide cleaning services for the facility. During interviews with staff, staff stated they have not witness facility unsanitary. S1 and S2 stated they have assigned rooms where the provide cleaning services for residents. S3 informed LPA they have certain task they must complete to keep facility sanitary. During interviews with residents, the residents stated they have not witnessed the facility being unsanitary. Unsubstantiated During document review, LPA discovered facility has enough staff to provide cleaning services for the facility. LPA reviewed housekeeping task. Administrator provided the following documents: housekeeping schedule, LIC 9020A, LIC 500, Resident’s Admission Agreement, Memory and Assisting Living Schedule. During facility tour, LPA observed Memory and Assisting Living building sanitary. For allegation, Residents are not provided proper assistance by facility staff. During interview with Administrator, Administrator stated they have two (2) care givers in Memory and two (2) care givers Assisted Living who provide proper assistance to residents.During interviews with staff, staff informed LPA they provide proper assistance to residents. S3 and S4 informed LPA they provide proper assistances with resident’s ADLs. Staff members stated they have not witness facility staff not providing proper assistance. During facility tour, LPA observed facility staff providing proper assistance. For allegation, Residents in care are not provided proper bedding. During interview with Administrator, Administrator stated residents provide their own bedding. Administrator informed LPA residents who are independent prefer to make their own bed and residents who need assistance are require helped by staff. During interviews with staff, staff stated residents provide their own bedding. S1 informed LPA residents have extra beddings, where they can be replaced when an accident occurs. S3 and S4 stated they assistance residents with their bedding. During facility tour, LPA observed proper bedding for residents and extra beddings for residents in care. Based on the evidence found during the investigation, the three (3) allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report was discussed and provided to Administrator Usman Chaudary, along with a copy of the appeal rights.the state’s words, verbatim · CDSS document, Sep 13, 2023 · control 56-AS-20230906094211

Allegation investigated: Staff mishandling residents medication. Staff not keeping an accurate medication log.

On 08/11/2023, Licensing Program Analyst (LPA), Venus Mixson conducted a visit to the facility and met with the Administrator. The visit was conducted in order to provide the findings for the investigation pertaining to the listed allegations. During the investigation, the LPAs conducted interviews with the Administrator, a number of staff and residents, and reviewed records. On June 03, 2020, Community Care Licensing (CCL), received information stating the facility staff are mishandling the resident’s medication, and the facility staff do not keep accurate medication logs. Regarding the allegation the facility staff are mishandling the resident’s medication, information obtained from interviews and record reviews revealed the facility staff are following the facility medication protocols, and there was not sufficient evidence of staff mishandling the resident’s medication. Regarding the allegation, the facility staff do not keep accurate medication logs, information obtained from staff and resident interviews, record reviews, and observations, the information obtained revealed the facility staff have received several training's on proper medication management and procedures. Additional information received showed there were no medication log errors observed or documented on the routine medication logs reviewed. The information received from the record reviews did not reveal any medication log inaccuracies, and/or errors found in the medication logs. Based on staff and resident interviews, record reviews, and observations the allegations findings have been deemed "UNSUBSTANTIATED." An allegation finding of unsubstantiated means, "although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated." An exit interview was conducted and a copy of this report was provided to was provided to the Administrator. Unsubstantiatedthe state’s words, verbatim · CDSS document, Aug 11, 2023 · control 18-AS-20200603143212

Type of visit: Case Management - Other

On 5/20/2022 Licensing Program Analyst (LPA) Bernadette Allen was at the facility to initiate a complaint investigation CONTROL NUMBER 56-AS-20220518164927. LPA Allen met with Jeanane St. Louis -Business Office Director she was informed that the LIC-9099-D was amended and needed to be signed. Jeanane informed me that David Tamo was not available but she could sign the required document. No Deficiencies were cited at the time of visit. An exit interview was conducted where this report was discussed and signed by Jeanane St.Louis a copy was provided at the conclusion of the visit.the state’s words, verbatim · CDSS document, Dec 14, 2022

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Natalie Ibarra and Paola Guerrero made an unannounced visit to conduct an annual inspection, with emphasis on infection control. LPAs met with administrator David Tamo and explained the purpose to today's visit. Administrator accompanied LPAs on a tour of the facility. LPAs toured the facility and made observations pertaining to the facility’s infection control measures. LPAs observed signage throughout the facility for proper cough etiquette, hand washing procedure, and/or social distancing guidelines. The residents have hand sanitizer available to them throughout the facility, and the bathrooms were stocked with hand soap and paper towels. Facility has sufficient hand hygiene, cleaning, and disinfecting supplies. The staff working at the facility were all properly wearing face masks. LPAs requested to inspect the facility's Personal Protective Equipment (PPE) supply. The facility has a full thirty (30) day supply of PPEs such as gloves, face shields, gowns, surgical masks, N95 masks, disinfectant, and hand sanitizer. LPAs observed one central entry point and a sign-in has been designated for screening that includes a vaccination verification/negative COVID test check, temperature check, and symptom check. The facility has a designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases, cleaning and disinfection provisions are in adequate quantities, and that staff are trained in overall infection control. The facility has a plan in place which follows Community Care Licensing guidelines for when and how long to test staff and residents for COVID-19, when and how to isolate/quarantine residents, and when to schedule cleaning and disinfection times of high traffic and frequently touched areas. The facility also has a plan in place to monitor residents regularly for any changes in condition and to subsequently notify the client's physician and to notify all emergency agencies in the event of any COVID-19 related and/or suspected illnesses. No deficiencies were cited during today’s visit An exit interview was conducted, and a copy of this report was discussed and provided to Administrator David Tamo...the state’s words, verbatim · CDSS document, Oct 13, 2022

Allegation investigated: Licensee refused to allow resident to return to the facily after discharge from the hospital.

Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to the facility to investigate the above allegation. LPA met with licensee David Tamo Administrator. Based on interview and observations of documents the administrator David Tamo confirmed that (R1) has not been allowed to return to the facility unless 24hr care could be provided upon (R1) return to assist with his higher level of care. Based on LPA's observations, interviews, and record reviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6 & Chapter 8), is being cited on the attached LIC9099D. An exit interview was conducted where this report, LIC9099D and appeal rights were provided to Administrator David Tamo. Substantiatedthe state’s words, verbatim · CDSS document, May 20, 2022 · control 56-AS-20220518164927

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(a) · Plan of correction due date: May 20, 2022

Eviction Procedures-The licensee may evict a resident for one or more of the reasons listed in Section 87224(a) (1) through (5). Thirty (30) days written notice to the resident is required except as otherwise specified in paragraph 5.This requirement is not met as evidenced by: The licensee refused to allow the resident back into the facily after being discharged from the hospital unless 24 hour care is provided. The licenssee did not do a reassesment, or provide R1with a 30day eviction notice.the state’s words, verbatim · CDSS document, May 20, 2022

Plan of correction: Licensee has agreed to review Title 22, Section 87224(a) (1 through 5) and write a self certification that the regulation has been read and is understood. Proof of correction due to the Department by 5/23/2022.

Type of visit: Required - 1 Year

On 11/1/21 Licensing Program Analyst (LPA) Shaunte Henry arrived at the facility to conduct an unannounced annual inspection with an emphasis on infection control. LPA met with general manager, David Tamo, explained the nature of the inspection and was granted entry into the facility. LPA’s temperature was taken with an infrared/temporal thermometer and the LPA was screened for COVID-19 symptoms. There are currently 170 residents at the facility within the assisted living and memory care buildings. 167 out of 170 residents are fully vaccinated. All staff are fully vaccinated. As of this date, there are no positive COVID-19 cases or individuals with COVID-like symptoms present in the facility. LPA toured Building A (Assisted Living) and Building B (Memory Care) with the general manager. There is one point of entry for routine COVID-19 symptoms screening is initiated for all residents, staff and visitors. Signs have been posted throughout the facility which indicates the visitor policy and proper hand washing, cough/sneeze etiquette, and social distancing practices. Facility also documents daily temperature and COVID-19 symptom checks, and any change in condition for staff and residents. LPA observed hand sanitizer throughout the facility. LPAs observed a sufficient supply of hand hygiene, cleaning and disinfecting items. LPAs observed a sufficient supply of Personal Protective Equipment (PPE) that included surgical masks, N-95 masks, face shields, gloves, gowns, glasses, etc. The facility has a designated infection control person who is responsible for ensuring that the facility is compliance with infection control practices. The facility has a COVID-19 mitigation plan in place, which outlines testing requirements, isolating/quarantining positive COVID-19 cases, proper cleaning/sanitizing/disinfecting and monitoring of individuals for COVID-like symptoms. The facility is aware that it is mandatory that CCL is contacted if anyone tests positive for COVID-19. According to California Code of Regulations, Title 22, Division 6, there were no deficiencies observed or cited during this visit. An exit interview was conducted where this report was discussed with and provided to David Tamo.the state’s words, verbatim · CDSS document, Nov 1, 2021