Merrill Gardens at Campbell

LPA interviewed General Manger (GM) Alex Den. GM states R1 was reassessed by the facility on 2/3/2025 when R1 was observed to be confused while walking around the facility. GM states R1 also had an incident that caused water damage to the facility in February 2025. LPA interviewed 1 Staff (S1). S1 states he/she reassessed R1 on 2/3/2025 when R1 was observed to be confused while walking in the facility, an observed change of condition. S1 states extra support for R1 to include reminders, redirection and staff checking on R1 every 2 hours began on 2/9/2025. LPA interviewed 11 Residents (R1 to R11). 11 Out of 11 residents stated they have no issues or concerns with the care they are receiving. Based on review of documentation, R1’s physician’s reports are dated 4/21/2016, with R1’s mental condition listed as able to follow instructions, able to communicate needs, able to leave unassisted. No diagnosis or medical conditions listed. R1’s physician’s report dated 2/6/2025 states R1’s has diagnosis of major neurocognitive disorder, and mild cognitive impairment. Review of an additional medical assessment of R1 was conducted on 3/27/2025, which noted R1 to have mixed neurocognitive disorder. Facility did not provide eviction letter It has been alleged by the RP that the facility did not provide an eviction letter to R1. RP states the facility verbally tried evict R1 on 6/18/2025, if R1 did not move into the memory care within the facility. RP states he/she requested the eviction in writing, and the facility did not provide an eviction notice. LPA interviewed GM. GM states he/she met with RP and had a 'chat' and a recommendation was made for R1 to move into memory care. GM states R1 was not being evicted. LPA interviewed S1. S1 states there was never any eviction for R1, only a recommendation for R1 to move into memory care, which was shared with RP during a care conference. LPA interviewed 11 Residents (R1 to R11). 11 Out of 11 residents stated they have no issues or concerns with the care they are receiving. Page 2 of 3 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Facility did not allow 1:1 private care for resident It has been alleged by the RP that the facility did not allow 1:1 care for R1 in February 2025 when R1 caused water damaged at the facility. RP states he/she was told by GM that 1:1 care was not allowed. LPA interviewed GM. GM states R1 is receiving additional support from staff after the incident of water damage by R1 in February 2025. GM states RP did not allow recommended 1:1 care for R1 on multiple occasions. GM did not remember dates of this incident. LPA interviewed S1. S1 states R1 has been provided additional staff support since 2/9/2025 to include reminders, redirection and staff checking on R1 every 2 hours. S1 did not provided additional information regarding 1: 1 care for R1. LPA interviewed 11 Residents (R1 to R11). 11 Out of 11 residents stated they have no issues or concerns with the care they are receiving. Based on review of documentation, R1 has been receiving additional staff support since 2/9/2025. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED . An exit interview was conducted, and a copy of this report was provided

Licensing Program Analyst (LPA) Marcella Tarin arrived unannounced to conduct a Plan of Corrections visit for a deficiency cited on 10/14/2025. LPA met with General Manager (GM) Alex Den. LPA stated the purpose of the visit. On 10/14/2025 during the facility's annual inspection, LPA Tarin observed a Clorox toilet bowl cleaner in a storage cabinet above the toilet in Resident R10's room in Garden House (Memory Care). A Type A deficiency was issued with a Plan of Correction due date of 10/15/2025. GM submitted POC by POC due date 10/15/2025. During today's visit, LPA toured 5 random resident rooms in Garden House and did not observe disinfectants or cleaning solutions which could pose a danger to residents in care. A Letter of Deficiency Citations Cleared was provided to GM during today's visit. No deficiencies were cited during today's visit per California Code of Regulations, Title 22. An exit interview was conducted with GM Alex Den and a signed copy of this report was provided.

Licensing Program Analyst (LPA) Marcella Tarin arrived unannounced to conduct a case management to follow up on deficiencies that were cited on 10/28/2024. LPA Tarin met with Administrator (ADM) Bradley Burgoyne. On 10/28/2024, LPA Tarin conducted the facility's annual inspection. During resident record review, LPA Tarin observed Resident records for R2 and R3, did not contain updated physician's reports. Resident R2 and R3 physician's reports were not updated within the year. R2 and R3 have neurocognitive disorder. During staff record review, LPA Tarin observed 3 out of 8 staff (S2, S6, and S7) records did not contain CPR/first aid training. During today's visit, LPA Tarin reviewed documentation for S2 and S7 to have completed CPR/First Aid training on 10/28/2024. ADM stated S6 has completed the CPR/First Aid training, but has not obtained the certificate. ADM states the facility will email a copy of S6's CPR/First Aid training once it is obtained. LPA Tarin reviewed updated physician's reports for R2, updated on 09/24/2024. ADM states R3 had a video appointment with his/her physician on 11/7/2024, and is awaiting a copy of the updated physician's report. ADM states the facility will email a copy of R3's updated physician's report once it is received. LPA Tarin cleared the deficiencies cited on 10/28/2024 during today's visit. A Letter of Deficiency Citations Cleared was printed and provided to ADM. No deficiencies were cited during todays visit. A copy of this report was provided to ADM Bradley Burgoyne.

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Case Management - Incident visit and met with Bradley Burgoyne. The purpose of the visit was to follow up with an incident self-reported by the facility in which staff S1 was allegedly observed to have hit resident R1 on the back of the head. During visit, LPA Marrufo obtained resident records for R1 and training records for S1. Staff S1 was not present during visit and was not interviewed. During visit, LPA Marrufo conducted a wellness check and observation of R1. No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Administrator Bradley Burgoyne and a copy of this report was provided.

Licensing Program Analyst Ryker Heberle (LPA) conducted an unannounced case management visit regarding an incident report received detailing a resident elopement from the facility. LPA met with facility general manager Scott Shahade and resident care director Sarum Talivaa (Admins). Admins provided more details regarding the resident (R1) elopement. R1 is a resident that currently resides in the Garden House memory care unit and is not permitted to leave the facility unattended as stipulated in their physician's report. Admins stated that while R1 eloped from the memory care unit, they did not elope from the facility. Facility staff believes that R1 was able to exit the memory care unit while following a facility guest outside of the unit. From there, R1 went to the facility front desk en route to her old apartment in the facility's assisted living wing. R1 was noticed by front desk staff, who alerted memory care staff, who then successfully redirected R1 back to the assisted living unit. Admins reiterated that R1 never left the facility. Since the elopement, Admins have conducted multiple in-service training sessions regarding exit seeking and elopement prevention. Facility has also increased staffing levels in the Garden House, no longer contracts caregivers through outside agencies into the Garden House, changed the number combinations on the locked doors, and has hired a full time manager for the memory care unit. Facility has experienced no additional elopements since R1's incident. No deficiencies cited during today's visit. This report was reviewed with facility resident care director Sarum Talivaa and a digital copy of the report was provided via email due to printer error.

Licensing Program Analyst (LPA) Ryker Heberle conducted an annual inspection today and met with Residential Services Manager Sarum Talivaa (RSM). At 01:20 PM, LPA entered the facility through the main entrance point and was screened by staff. COVID-19 postings were observed in the hallways and common areas. Staff were observed wearing face coverings. Ceiling noted to be damaged in previous facility inspection noted to have been repaired. All bathrooms noted to have handwashing signs, lidded trash cans soap and paper towels. Facility temperature noted to be between 68*F and 77*F. Facility water temperature measured to be between 110.2*F and 114.7*F. Fire extinguishers noted to be last inspected in March of 2022. No prohibited items noted in inspected resident rooms. All emergency exits noted to be clear of obstruction. Delayed egress doors tested and noted to be functioning properly. Hand sanitizers, soap, and paper supplies were observed available. At least 30 days' supply of personal protective equipment (PPE) were available in the premises. Per Administrator, the facility is currently accepting visitors inside the facility, including residents' bedrooms. The facility has reached a 100% COVID-19 vaccination rate for staff and 100% for residents. The facility's COVID-19 infectious control plan has been reviewed and is still in place. No deficiencies were cited. No advisory notes issued. Exit interview conducted with GM and a copy of this report was provided during visit.

Licensing Program Analyst (LPA) Ryker Heberle conducted an annual inspection today and met with General Manager Joyce Welch (GM). At 10:00 AM, LPA entered the facility through the main entrance point and was screened by staff. At 10:05 AM, a tour of the facility's assisted living building B was conducted with staff. COVID-19 postings were observed in the hallways and some, but not all common areas. Staff were observed wearing face coverings. Bistro ceiling noted to have ceiling tiles missing, GM indicated that a resident accidentally flooded their bathroom, and it caused leaking from the ceiling on 10/11/2021. Facility is currently ensuring that there is no water damage and that the area has fully dried. Facility already have ceiling tiles ready to replace the damaged ones. During tour of building D, LPA noted that public bathrooms did not have handwashing signs, or lidded trash cans and one bathroom was out of paper towels. Paper towels were restocked moments later. Facility temperature noted to be between 68*F and 79*F. Facility water temperature measured to be between 115.5*F and 116.0*F. Fire extinguishers noted to be last inspected in March of 2021. Hand sanitizers, soap, and paper supplies were observed available. At least 30 days' supply of personal protective equipment (PPE) were available in the premises. Per Administrator, the facility is currently accepting visitors inside the facility, including residents' bedrooms. The facility has reached a 100% COVID-19 vaccination rate for staff and 100% save 1 for residents. The facility's COVID-19 mitigation plan has been reviewed and is still in place. No deficiencies were cited. Advisory notes issued. Exit interview conducted with GM and a copy of this report was provided during visit.