Merrill Gardens at Huntington Beach.

Medication Administration Record’s for Resident 1 (R1) for December 2021, January 2022, February 2022, April 2022 and December 2022. Record review for MAR February 2022 revealed the following with medications in question, inhalers Symbicort and Trelegy. LPA observed two separate MAR’s for February 2022, one MAR had a note stating R1’s Symbicort inhaler was discontinued on 2/26/2022. On same MAR, shows R1’s Trelegy inhaler started on 2/24/2022 with a written note stating “re-write 2/26/2022” with initials. Second MAR for R1 shows Trelegy starting on 2/26/2022 with initials dispensed medication. Investigation revealed staff initials are unclear as to who marked each MAR. Guardian Pharmacy Services Audit report states R1 medications were reviewed on 3/10/2022 stating minor instructions regarding R1’s Trelegy Inhaler to swish around with water and no other discrepancies were notated on report. Interviews conducted with staff revealed that Medication Technicians, Nurse and Caregivers who have medication training can dispense medication to residents. Staff interviews revealed that staff who dispense meds need to document on an Electronic MAR (E-MAR) and if E-MAR is down or unavailable, staff are to document on paper MAR. Staff interviews stated that staff have to sign off on MAR’s regardless if resident takes meds or refuses, there needs to be a signature & note if refused. Interviews with staff stated that in order for new medications to be dispensed, facility needs medication to be uploaded in E-MAR, doctors order, and physical medication needs to be on hand. Interview with witness states that R1 was delivered new inhaler medication on 2/24/2022 and wasn’t given until later to start. Witness interview stated that R1’s Symbicort medication was discontinued and was still present in R1’s room 4 days later. Witness 1 states they feel facility is altering R1’s MAR and certain staff aren’t qualified to give out meds. Regarding Allegation Facility increased resident's rent without proper notification Record review conducted and LPA observed a notification letter from General Manager stating that a rent increase of $4275.00 will go into effect January 1, 2023 to December 31, 2023. Letter mentions that rate increases generally occur on anniversary date into community. Interview with Staff 1 stated that Notification of increase was given facility wide to all residents a year in advance due to facility not having fee increases in a long period of time. S1 stated that R1 was given a recent resident level of care increase not rent. Interview with Witness 1 states that when R1 was given March 2022 Bill that a $1000 increase in change in level of care that responsible party was not notified. CONTINUED ON 9099C 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 Regarding Allegation Staff did not assess resident for change in level of care . Record review was conducted and LPA observed R1’s Resident Service Agreement dated 12/17/2021 with signed signatures from facility, responsible party and resident agreeing that R1 agreed to living accommodations for a care level of 4. LPA observed a Change in services forms dated 1/27/22 and 2/6/22 indicated that R1 changed from a level 4 to level 5 showing a care level increase of $370. A Change in services form dated 3/8/22 shows that R1 went back to a level of 4 care and increase was refunded. R1 had another change in services form dated 6/1/22 changing from level 4 to level 3 with a care decrease of $380. Staff interviews stated that Facility Nurse is the one who assesses residents for changes in level of care. Staff interviews stated that if a change in services form is completed then an assessment was recently conducted for resident. Interview with Witness 1 stated that no assessment was done and that Administrator claimed they completed one on 3/8/22 but Witness stated that Administrator did not wish to show Witness 1. Based on the conflicting information gathered from investigation, the allegations Staff are mismanaging resident's medication, Staff are not properly documenting the MAR, Facility increased resident's rent without proper notification and Staff did not assess resident for change in level of care are deemed unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred as reported. An exit interview was conducted with Executive Director Nestor Mendez and copy of report was discussed and provided.

When residents were asked how facility was short staffed, residents replied that facility doesn’t have enough servers for meals. Seven of Eight residents interviewed stated that there are staff available to them if need assistance. Per interviews conducted with Staff, Seven staff members were interviewed. Seven of Seven Staff stated that most of the Assisted living side of facility is Independent while Memory Care side is fully dependent. Three of Seven staff stated that about 20% of residents in Assisted Living side of facility require care services for Activities of Daily Living (ADL’s). Five of Seven staff stated that facility has on AM shift two Caregivers and one Medication Technician in Assisted living and three Caregivers and one Medication Technician in Memory Care. Staff stated that for PM shift the numbers drop to two Caregivers, one reliever staff and one Medication Technician for PM and NOC shifts. Staff interviews revealed that facility used agency in the past whenever there was an outbreak of flu or covid amongst reason for staff calling off. Per Record Review, Department observed that in July of 2021 Assisted Living schedule shows that three caregivers were present on both sides for AM/PM shifts with one Medication Technician. Schedule shows NOC shift had one caregiver per side and one Medication Technician for entire building. Assisted Living Shower Schedule showed that in July of 2021, 27 residents required showering services. Staff Rosters from 2021 show that facility has eight care staff in Assisted Living and eleven in Memory Care. Recent Facility schedules for the year of 2025 were obtained and Department observed coverage for both Assisted Living and Memory Care, staff was providing care. Regarding Allegation Facility did not meet residents needs : It was reported that Resident 1 (R1) was left all night with a soiled diaper and on different occasion it took staff one and half hours to help transfer R1 from recliner to bed, as a result it was reported that residents were not having their needs being met by staff. Per interviews conducted with residents, Eight Residents were interviewed. Eight of eight residents stated that their needs were being met by facility staff. Residents stated that meals were being provided and care was available to to them such as showering if needed by staff. R1 stated that they get meals, assistance with medications and help with the bathroom. R1 stated they feel safe and that staff are nice and helpful to them. CONTINUED ON 9099C 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 Per interviews conducted with staff, Seven staff were interviewed. Five of Seven staff stated that when responded to a call or page the expected time to respond is immediately between 5 to 10 minutes. Three of Seven staff stated that they communicate with each other regarding calls when received. Three of Seven staff stated that when R1 was on Assisted Living side, resident was very independent and one staff stated that they had helped R1 with soiled diaper on one occasion. Three of seven staff stated that R1 needed full assistance once in Memory care side. Seven of seven staff stated they all feel they are meeting the needs of the residents who require care services. Per Record review, facility did not have incident reports to provide related to R1. Per Record review, a call log for July of 2021 was provided and shows that one emergency call was from Resident 1 room and log shows it took staff 11 minutes to respond and clear call. Resident Assessment dated 7/6/2021 stated at the time R1 required stand by assistance with toileting, and R1 had no reported incontinence issues. Based on information provided, the allegations Facility is not properly staffed and Facility did not meet residents needs are deemed UNSUBSTANTIATED, meaning that although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred as reported. An exit interview was conducted with General Manager Nestor Mendez and copy of report was discussed and provided to Manager.

Licensing Program Analysts (LPAs) Kimberly Lyman and Andrea Mendivil conducted an unannounced visit to Merrill Gardens at Huntington Beach. The purpose of today’s visit was to conduct the Annual Required inspection. LPAs were allowed entry into the facility and explained the reason for the visit. The facility is licensed for one hundred fifty non-ambulatory residents of which fifteen may be Bedridden. There is an approved hospice waiver for fifteen residents and there are three Hospice residents present during today’s visit. This is a three story with attached Memory Care facility. The facility is 121 private apartment facility. There are 115 residents present during facility visit. Jill Johnson has an administrator certificate expiring on 09/28/2026. LPAs Lyman and Mendivil along with Business Office Manager toured the facility at 9:11 AM. LPAs toured the physical plant, checked food service, facility records and the first aid kit. Facility appears to be clean, safe, and sanitary. Facility consists of assisted living and memory care unit, outside patio areas, two dining rooms, beauty salon, Wellness center, movie theater, bistro and activity areas. Resident apartments had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. LPAs observed one resident with half bed rails. Resident restrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 106.7 and 115.7 degrees F in resident restrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Staff responded within 2 minutes for emergency pull. Common areas were clean and clear of hazards, doorways were free of obstructions. First aid kit had all the required elements including tweezers, thermometer, and scissors. LPAs observed no unsecured cleaning supplies. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Facility is keeping a log of freezer/ refrigerator temperatures and all were in range. Smoke detectors and fire inspections CONTINUED ON LIC 809C DATED 10/24/2025 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 are conducted by an outside company, Cosco Fire, with the last inspection date of 10/08/2025. Fire extinguishers are fully charged. LPAs observed evacuation chairs at stairwells. LPAs toured the outside grounds and there is ample shaded seating for residents. LPAs observed ample emergency food and water. Facility conducts quarterly emergency drills with the last drill conducted on 10/01/2025. Facility provides activities in the form of games, exercise, and outings. LPAs observed residents participating in activities during the visit. LPAs spoke with residents during the visit who stated satisfaction with facility services and verbalized feeling safe. LPAs observed no health or safety concerns during the visit. LPAs reviewed select resident and staff files. Resident files contained required documents including admission agreements, current physician reports and resident appraisals. Staff files reviewed contained required documentation such as health screen/TB, training and criminal record clearance. Licensee to forward proof of liability insurance to LPA by close of business today, 10/24/2025. Based on the observations made during today's visit, no deficiencies are being cited. Exit interview conducted and a copy of this report was given at time of visit.

On 11/1/2024, Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced required visit using the CARE Inspection Tool. LPA was greeted by staff and granted entry after stating the purpose of the visit. Executive Director (ED) Jill Johnson was present to assist with the facility inspection on today's date. The facility is licensed for one hundred fifty (150) non-ambulatory residents with approved hospice waiver for fifteen (15) residents and fifteen (15) Bedridden. Currently, there are three (3) Hospice residents present during today’s visit. This is a three story with attached Memory Care facility . The facility is 121 private apartment facility. There are 112 residents present during facility visit. At around 10:16AM, LPA conducted a tour of the physical plant accompanied by Executive Director, and the following was observed: There were no bodies of water on the premises. All resident rooms observed met department regulations. LPA inspected 15 resident rooms. Resident beds and bedding supplies were in operational condition, lighting was provided, and storage for the residents personal belongings was observed. Bed linens, comforters, and bath towels were available during the visit. LPA checked water temperature in 9 resident Bathrooms and found water temperature measured between 106.5 to 115.3 degrees F. A comfortable temperature of 78 degrees F. was maintained in the facility. LPA observed the facility to be furnished at the time of the visit. The kitchen was inspected, and sufficient perishable and non-perishable food was maintained adequately. LPA observed emergency food and water supply. Facility has 5 drums of emergency water. Facility has Easy meal kits that feed 25 individuals per kit. LPA observed 25 boxes of meal kits. LPA observed eight fire extinguishers all mounted and fully charged. A review of the Medication Records Administration (MAR) was conducted, and LPA observed of the records reviewed all are in compliance. CONTINUED ON 809C 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 During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. LPA observed the facility has a supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. During visit LPA observed residents relaxing in dining room or common areas eating meals, playing card games and reading newspapers. LPA observed several residents relaxing inside private apartments watching TV and or knitting. LPA observed First Aid Kit was maintained. A working landline phone was operational. The last fire drill was conducted on 10/11/24. The facility had operational smoke and carbon monoxide in bedrooms and common areas. LPA observed documentation from Cosco Fire Protection and Direct Supply Tels. confirming 229 smoke detectors passed on inspection date 10/15/2024. The facility has current liability insurance on file effective 01/01/2024 - 01/01/2025. The facility is current on Community Care Licensing annual dues. A review of five residents (R1-R5) service files and four staff (S1-S4) personnel files revealed to be complete. Facility has a secured location for resident medication and files. No deficiencies during this inspection visit. An exit interview was conducted with Executive Director, and a copy of the report was provided.

CONTINUED FROM FORM LIC9099 Regarding the allegation that Staff mishandled a resident's medication while in care , the following has been concluded: Interviews and review of records confirmed that resident R1 was unable to receive the medication Tolvaptan as prescribed by their primary care physician on one instance on February 24, 2024 after the facility exhausted their current supply of the medication. However, interviews with facility staff evidenced that the medication had been identified to require a refill as early as February 5, 2024. Facility medication staff reached out to the pharmacy in charge of filling the medication orders for R1 at that time and were informed that the refill was pending approval from the resident's health insurance provider. Per the medication staff communication log, additional follow-up calls were placed on February 7, February 12, February 20 and February 24 as well as on February 27, 2024. There are documented instances of such pre-approvals being granted by insurance in the past, however in that instance the pre-authorization was alleged declined and is currently pending appeal to the insurance provider. In the meantime, due to the reported prohibitive cost of the medication, R1 has been provided with samples provided by the primary care provider in order to maintain the prescribed dispensation schedule and avoid any adverse effects. A review of the medication administration records and multiple interviews confirmed that R1 has since been receiving every dose as prescribed. Based on the evidence gathered, it cannot be determined that the missed medication dose was the result of a negligence from facility staff, therefore the allegation is found to be Unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred. An exit interview was conducted and a copy of this report was provided to a facility representative.

Interviews conducted with three out of the three staff confirmed that the residents immediately began their treatment, all residents' units including the bathrooms are cleaned/disinfected daily including their clothing items and linens, residents are receiving showers daily, and the common areas are vacuumed and disinfected daily as required per policy. It is alleged that the facility did not notify the residents and responsible parties of the scabies outbreak. LPA reviewed all residents' progress notes which indicated that the families were verbally informed of the scabies outbreak and facility requested consent to administer the scabies medication. Therefore, based on the observations made, interviews which were conducted, and the records that were reviewed, 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 following allegations: Facility is not following universal precautions/infection control with residents, staff, and visitors and Facility did not notify residents and responsible parties of scabies outbreak are deemed UNSUBSTANTIATED. An exit interview was conducted with General Manager Jill Johnson, and a copy of this report was provided at the end of the visit.

The Facility Administrator confirmed that during the time of the initial complaint several staff members left or were let go due to unsatisfactory job performance and attendance issues. During Time of COVID Pandemic, facility used staffing agency to help fill shifts. Of the staff members mentioned in the complaint, two of six resigned while four members were terminated due to write ups for excessive breaks, tardiness, and attendance issues. Staff members mentioned in the complaint have no longer been working at the facility as of September 13, 2023. Interviews conducted with residents revealed that seven of seven residents interviewed stated they had no concerns with the staff at the facility and that facility provides good care to residents. Residents interviewed state they have not witnessed any kind of neglect or abuse. Long Term Care Ombudsman interview also revealed they had no concerns about the residents in care. Interviews revealed that Administrator was unaware of issues of abuse on residents in facility. Three of four staff members confirmed that Administrator was knowledgeable of issues with staff in facility and stated that Administrator would try to resolve issues that occurred. In relation to staff members mentioned in complaint, Administrator maintained Documented Discussions violating facility policies which Administrator addressed staff compliance issues and had staff sign that they participated in discussion. Based on observations made from interviews conducted and records reviewed, LPA is unable to corroborate allegations made that Facility staff are physically abusing residents, facility staff neglected resident and Administrator failed to address reports of abuse therefore 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 above allegations are deemed UNSUBSTANTIATED. An exit interview was conducted with Administrator Jill Johnson, and a copy of this report was provided during this visit.