Inspection Reports for Merrill Gardens at Brentwood
2600 Balfour Rd, Brentwood, CA 94513, CA, 94513
Back to Facility ProfileInspection Report Summary
Most inspections found no deficiencies, with several complaint investigations determined to be unsubstantiated. However, some reports documented isolated issues related primarily to staffing shortages and medication management, including medication left unsecured and delayed response to resident calls. The facility was cited for insufficient personnel affecting resident care in the most recent report dated August 28, 2025. Earlier substantiated complaints included improper medication storage and failure to provide timely assistance, but no fines or enforcement actions such as license suspensions were listed in the available reports. While some deficiencies appeared sporadically over time, the facility’s April 16, 2025 annual inspection was clean, indicating some improvement before the latest citation.
Deficiencies per Year
4
3
2
1
0
High
Moderate
Unclassified
Census Over Time
Census
Capacity
Inspection Report
Complaint Investigation
Census: 112
Capacity: 150
Deficiencies: 1
Aug 28, 2025
Visit Reason
Unannounced complaint investigation visit conducted due to an allegation that staff did not respond to resident's calls for assistance in a timely manner.
Findings
Investigation substantiated the allegation that staff failed to respond timely to a resident's call button, with documented response time exceeding five hours. The facility was cited for insufficient personnel to provide necessary services, posing a potential health and safety risk.
Complaint Details
Allegation that staff did not respond to resident's calls for assistance in a timely manner was substantiated based on interviews and record review showing a call initiated at 11:24pm and response at 5:22am.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Facility personnel did not respond to call button in a timely manner, violating personnel requirements to provide necessary services. | Type B |
Report Facts
Census: 112
Total Capacity: 150
Response Time (hours): 5.97
Deficiency Count: 1
Plan of Correction Due Date: Sep 4, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jeryl Shields | Administrator | Named as facility administrator in report header |
| Lydia Hertzler | Executive Director | Met with Licensing Program Analyst during investigation and exit interview |
| Tonica Syess-Gibson | Licensing Program Analyst | Conducted the complaint investigation |
| Harpreet Humpal | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
Inspection Report
Annual Inspection
Census: 138
Capacity: 150
Deficiencies: 0
Apr 16, 2025
Visit Reason
The inspection visit was an unannounced 1-Year Annual Required inspection to evaluate compliance with licensing requirements.
Findings
The Licensing Program Analyst toured the facility and observed that all areas were maintained safely and adequately. No deficiencies were found during the visit, and staff and resident records were current and complete.
Report Facts
Fire clearance: 135
Fire clearance: 15
Hospice waiver: 15
Hot water temperature: 109.5
Fire extinguisher last serviced: Apr 14, 2025
Staff records reviewed: 10
Resident records reviewed: 10
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jeryl Shields | Administrator/Director | Named as facility administrator |
| Lydia Hertzler | General Manager | Met with Licensing Program Analyst during inspection |
| Tonica Syess-Gibson | Licensing Program Analyst | Conducted the inspection visit |
| Harpreet Humpal | Licensing Program Manager | Named as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 131
Capacity: 150
Deficiencies: 1
Jan 23, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to allegations received on 2024-12-09 regarding medication accessibility, food poisoning, inadequate food service, and staffing for food service at Merrill Gardens at Brentwood.
Findings
The allegation that staff did not ensure medication was inaccessible to others was substantiated, with evidence that medication was left accessible in a resident's room. The allegations related to food poisoning, inadequate food service, and staffing for food service were unsubstantiated based on interviews and record reviews.
Complaint Details
The complaint investigation was substantiated for the allegation that staff did not ensure medication was inaccessible to others. The other allegations regarding food poisoning, inadequate food service, and staffing were unsubstantiated.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Medication was not kept in a safe and locked place inaccessible to persons other than responsible employees. | Type A |
Report Facts
Capacity: 150
Census: 131
Deficiency Type A: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tonica Syess-Gibson | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Harpreet Humpal | Licensing Program Manager | Oversaw the complaint investigation |
| Lydia Hertzler | General Manager | Met with Licensing Program Analyst during the investigation |
Inspection Report
Complaint Investigation
Census: 121
Capacity: 150
Deficiencies: 0
Dec 23, 2024
Visit Reason
The visit was an unannounced Case Management inspection conducted to provide the amended complaint from 12/17/2024 related to a prior complaint investigation.
Findings
The Licensing Program Analyst amended the complaint to show all allegations as unsubstantiated, including the initial substantiated allegation of short staffing, which was changed to unsubstantiated.
Complaint Details
The complaint investigation 15-AS-20241210103140 initially substantiated the allegation that the facility was short staffed; however, all allegations were later amended to be unsubstantiated.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tonica Syess-Gibson | Licensing Program Analyst | Conducted the complaint investigation and delivered the report. |
| Lydia Hertzler | General Manager/Administrator | Met with Licensing Program Analysts during the visit. |
| Jeryl Shields | Administrator/Director | Named as facility administrator. |
| Harpreet Humpal | Licensing Program Manager | Named as Licensing Program Manager. |
Inspection Report
Complaint Investigation
Capacity: 150
Deficiencies: 1
Dec 23, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation that staff do not provide adequate care and supervision to the residents.
Findings
The investigation found that the facility did not have sufficient staff to provide adequate care and supervision to residents, substantiating the complaint. Specific incidents included inadequate assistance during activities of daily living and lack of staff availability during a resident's bowel accident.
Complaint Details
The complaint alleged that staff do not provide adequate care and supervision to the residents. The allegation was substantiated based on interviews and record reviews. The preponderance of evidence standard was met. Health and Safety Code 1569.269(a)(6) was cited.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to provide care, supervision, and services that meet individual resident needs due to insufficient staff numbers, qualifications, and competency. | Type B |
Report Facts
Capacity: 150
Residents in Memory Care Unit: 19
Caregivers per shift: 2
Residents needing 2-person assist: 1
Residents who wander: 3
Residents needing 2-person assist with showers/changing: 4
Residents needing to be fed: 1
Residents on hospice: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lydia Hertzler | General Manager/Administrator | Met with Licensing Program Analysts during the investigation and exit interview |
| Tonica Syess-Gibson | Licensing Program Analyst | Conducted the complaint investigation |
| Harpreet Humpal | Licensing Program Manager | Oversaw the complaint investigation |
Inspection Report
Complaint Investigation
Census: 121
Capacity: 150
Deficiencies: 0
Dec 17, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to allegations received on 2024-12-10 regarding staffing shortages, staff treatment of residents, and facility security.
Findings
The investigation found that although some allegations such as staff shortages and facility security issues may have occurred or be valid, there was insufficient evidence to substantiate any violations. All allegations were determined to be unsubstantiated and no deficiencies were cited.
Complaint Details
The complaint involved multiple allegations including facility being short staffed, staff not treating residents with dignity and respect, and the facility being unsecured. After interviews with staff and residents and review of records, all allegations were found unsubstantiated due to lack of preponderance of evidence.
Report Facts
Capacity: 150
Census: 121
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jeryl Shields | Administrator | Named as facility administrator |
| Tonica Syess-Gibson | Licensing Program Analyst | Conducted the complaint investigation |
| Harpreet Humpal | Licensing Program Manager | Oversaw the complaint investigation |
| Lydia Hertzler | General Manager | Met with Licensing Program Analyst during investigation |
Inspection Report
Complaint Investigation
Census: 118
Capacity: 150
Deficiencies: 0
Aug 13, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by multiple allegations received on 2024-07-09 regarding infection control, reporting requirements, facility disrepair, temperature maintenance, and staff health.
Findings
The investigation found all allegations to be unsubstantiated. The facility followed infection control guidelines, submitted required reports timely, residents were not affected by HVAC issues despite kitchen disrepair, and staff health protocols were followed with COVID-19 positive staff isolating appropriately.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included failure to follow infection control guidelines, reporting requirements, facility disrepair, temperature maintenance, and ensuring staff health. Evidence showed compliance with infection control, timely reporting, and appropriate staff health measures.
Report Facts
Capacity: 150
Census: 118
Dates of Unusual Incident Reports: 3
Date of complaint received: Jul 9, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tonica Syess-Gibson | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Lydia Hertzler | General Manager/Administrator | Met with Licensing Program Analysts during the investigation |
| Harpreet Humpal | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Annual Inspection
Census: 130
Capacity: 150
Deficiencies: 0
May 9, 2024
Visit Reason
The inspection was an unannounced 1-Year Annual Required inspection visit to evaluate compliance with licensing requirements.
Findings
The Licensing Program Analysts toured the facility and reviewed staff and resident records, vehicle maintenance logs, and safety equipment. No deficiencies were observed during the visit, though several documents were requested to be submitted by 05/16/2024.
Report Facts
Fire clearance: 150
Hospice waiver residents: 15
Staff records reviewed: 10
Resident records reviewed: 10
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Carol Anthony | Business Office Director | Met with Licensing Program Analysts during inspection |
| Tonica Syess-Gibson | Licensing Program Analyst | Conducted inspection and signed report |
| Harpreet Humpal | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Capacity: 150
Deficiencies: 0
May 3, 2024
Visit Reason
The visit was an unannounced case management inspection conducted in response to an incident report received on 2024-04-29 regarding a resident's new diagnosis that the facility had not been previously made aware of.
Findings
The inspection found that the facility staff requested updated physician documentation and held a conference call with the resident's family regarding continuing care. No deficiencies were cited during this visit.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lydia Hertzler | Executive Director | Met with Licensing Program Analysts during the inspection and informed of the visit reason. |
| Tonica Syess-Gibson | Licensing Program Analyst | Conducted the case management visit. |
| Jeryl Shields | Administrator/Director | Named as facility administrator/director. |
Inspection Report
Complaint Investigation
Census: 120
Capacity: 150
Deficiencies: 0
Mar 7, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to allegations that staff does not prevent residents from falling in the shower and that the facility does not have a backup generator.
Findings
The investigation found that the facility does not have a backup generator but uses an inverter with battery packs providing electricity for 90 minutes, and staff are trained on safety procedures. Regarding falls in the shower, residents expressed concerns about falling and the need for additional grab bars, but installation requires written approval and residents are responsible for costs. Both allegations were determined to be unsubstantiated.
Complaint Details
The complaint investigation was unsubstantiated, meaning that although the allegations may have happened or are valid, there was not a preponderance of evidence to prove that the alleged violations occurred.
Report Facts
Capacity: 150
Census: 120
Electricity backup duration: 90
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Laura Hall | Evaluator / Licensing Program Analyst | Conducted the complaint investigation |
| Harpreet Humpal | Licensing Program Manager | Named in report as Licensing Program Manager |
| Lydia Hertzler | Executive Director | Facility representative met during the investigation |
Inspection Report
Complaint Investigation
Census: 111
Capacity: 150
Deficiencies: 0
Oct 12, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to allegations received on 2023-06-30 regarding staff sexually harassing a resident and failure to safeguard a resident's personal belongings.
Findings
The investigation included interviews with staff and residents and review of documents. The allegations were found to be unsubstantiated due to lack of preponderance of evidence to prove the violations occurred.
Complaint Details
The complaint involved allegations that staff sexually harassed a resident and did not safeguard the resident's personal belongings. Interviews revealed conflicting accounts and insufficient evidence to substantiate the claims, resulting in an unsubstantiated determination.
Report Facts
Capacity: 150
Census: 111
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jill Clancy-Czuleger | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Harpreet Humpal | Licensing Program Manager | Oversaw the complaint investigation |
| Jeryl Shields | Administrator | Facility administrator mentioned in the report header |
| Lydia Hertzler | General Manager | Met with Licensing Program Analyst during the investigation |
Inspection Report
Complaint Investigation
Census: 111
Capacity: 150
Deficiencies: 1
Oct 12, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by a complaint received on 2023-07-31 regarding allegations including illegal eviction, food quality, dining group restrictions, retaliation, and staff interactions with residents.
Findings
The investigation substantiated the allegation of illegal eviction due to issuance of a verbal eviction notice not following legal procedures. Other allegations including food quality issues, restrictions on large group dining, retaliation, and inappropriate staff interactions were found to be unsubstantiated based on interviews and evidence.
Complaint Details
The complaint investigation was substantiated for illegal eviction where a verbal eviction notice was issued improperly. Other allegations were unsubstantiated. The investigation was conducted by Licensing Program Analyst Jill Clancy-Czuleger and Licensing Program Manager Harpreet Humpal.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| The facility staff telling the resident that they are getting evicted before the notice was given to the resident | Type B |
Report Facts
Capacity: 150
Census: 111
Deficiencies cited: 1
Plan of Correction Due Date: Oct 26, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jill Clancy-Czuleger | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Harpreet Humpal | Licensing Program Manager | Oversaw the complaint investigation |
| Lydia Hertzler | General Manager | Facility representative met during the investigation |
| Jeryl Shields | Administrator | Facility administrator named in the report |
Inspection Report
Complaint Investigation
Census: 116
Capacity: 150
Deficiencies: 0
May 8, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to an allegation that a resident had a seizure due to incorrect dosage of medication.
Findings
The investigation found no proof that the seizure incident was caused by incorrect medication dosage by staff. Based on records and interviews, the resident had a history of seizures, and the allegation was unsubstantiated.
Complaint Details
The allegation was that a resident had a seizure due to incorrect dosage of medication. The complaint was found to be unsubstantiated as there was no preponderance of evidence to prove the allegation.
Report Facts
Complaint Control Number: 15-AS-20220606121156
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Leslie Ibo | Licensing Program Analyst | Conducted the complaint investigation visit and delivered the investigation findings. |
| Harpreet Humpal | Licensing Program Manager | Named in the report as Licensing Program Manager. |
| Lydia Hertzler | Administrator | Met with the Licensing Program Analyst during the investigation. |
Inspection Report
Complaint Investigation
Census: 116
Capacity: 150
Deficiencies: 1
May 8, 2023
Visit Reason
The inspection visit was an unannounced complaint investigation triggered by a complaint received on 2022-09-15 alleging that staff left a resident unattended on the floor for an extended period of time.
Findings
The investigation substantiated that staff failed to check on resident (R1) in a timely manner on multiple occasions, including no evidence of physical checks on 8/21/2022 and only a phone call with voicemail left on 8/22/2022, posing a potential health and safety risk to residents.
Complaint Details
The complaint was substantiated. The allegation was that staff left a resident on the floor unattended for an extended period of time. The investigation confirmed failure to timely check on the resident, posing a potential health and safety risk.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Staff failed to check resident (R1) on a timely manner, violating Additional Personal Rights of Residents in Privately Operated Facilities, specifically the right to be free from neglect. | Type B |
Report Facts
Capacity: 150
Census: 116
Deficiency Type: 1
Plan of Correction Due Date: May 19, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Leslie Ibo | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Harpreet Humpal | Licensing Program Manager | Oversaw the complaint investigation |
| Jeryl Shields | Administrator | Facility administrator involved in the investigation and agreed to conduct staff training |
| Lydia Hertzler | Administrator | Met with Licensing Program Analyst during the investigation |
Inspection Report
Complaint Investigation
Capacity: 150
Deficiencies: 0
Apr 4, 2023
Visit Reason
An unannounced complaint investigation visit was conducted in response to allegations including staff forcing a resident to shower, increasing level of care without resident's consent, and overcharging a resident in care.
Findings
The investigation found all allegations to be unsubstantiated based on interviews and records review. The resident was not forced to shower, the change in care level was discussed with the resident's representative but not implemented due to the resident moving out, and no overcharging occurred as charges were consistent and a prorated refund was issued.
Complaint Details
The complaint investigation was unannounced and conducted on 04/04/2023. The allegations were found to be unsubstantiated, meaning there was insufficient evidence to prove the allegations occurred.
Report Facts
Facility capacity: 150
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Leslie Ibo | Licensing Program Analyst | Conducted the complaint investigation visit |
| Harpreet Humpal | Licensing Program Manager | Named in report as Licensing Program Manager |
| Lydia Hertzler | Administrator | Met with Licensing Program Analyst during investigation |
| Jeryl Shields | Administrator | Named as facility administrator |
Inspection Report
Complaint Investigation
Census: 104
Capacity: 150
Deficiencies: 0
Jan 18, 2023
Visit Reason
An unannounced complaint investigation was conducted in response to an allegation that an authorized representative was being charged extra fees at the facility.
Findings
The investigation found no evidence of extra charges being added to the invoices. Interviews and records review showed that although extra fees were discussed, no charges were applied since the authorized representative did not agree to them. The allegation was determined to be unsubstantiated.
Complaint Details
The complaint alleged that an authorized representative was being charged extra fees. The allegation was found to be unsubstantiated based on records review and interviews, with no preponderance of evidence to prove the allegation.
Report Facts
Capacity: 150
Census: 104
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Leslie Ibo | Licensing Program Analyst | Conducted the complaint investigation |
| Harpreet Humpal | Licensing Program Manager | Oversaw the complaint investigation |
| Lydia Hertzler | Administrator | Facility administrator met during the investigation |
| Syritta Rogers | Facility Nurse | Facility nurse met during the investigation |
Inspection Report
Complaint Investigation
Census: 104
Capacity: 150
Deficiencies: 0
Jan 18, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to an allegation that the facility memory unit lacked adequate staffing to meet residents' needs.
Findings
The investigation found that the facility had sufficient staffing for all three shifts, with Med Tech, support staff, and agency staffing available. Residents were observed to be calm and comfortable, and staff interviews confirmed adequate staffing on the day in question. The allegation was found to be unsubstantiated due to lack of preponderance of evidence.
Complaint Details
The complaint alleged insufficient staff to meet the needs of the residents. The allegation was investigated and found to be unsubstantiated based on staff schedules, observations, and interviews.
Report Facts
Capacity: 150
Census: 104
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Leslie Ibo | Licensing Program Analyst | Conducted the complaint investigation |
| Lydia Hertzler | Administrator | Facility administrator met during investigation |
| Syritta Rogers | Facility Nurse | Facility nurse present during investigation |
| Harpreet Humpal | Licensing Program Manager | Oversaw the complaint investigation |
Inspection Report
Capacity: 150
Deficiencies: 1
Sep 20, 2022
Visit Reason
Unannounced case management visit conducted by Licensing Program Analyst Leslie Ibo to tour the facility and observe compliance with regulations.
Findings
A deficiency was observed where a resident's medication was unlocked and left on the bathroom sink countertop, posing an immediate health and safety risk. The administrator agreed to conduct in-service training for all staff to address this issue.
Deficiencies (1)
| Description |
|---|
| Resident's medication was unlocked and observed at the bathroom sink countertop, violating medication storage requirements. |
Report Facts
Capacity: 150
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jeryl Shields | Administrator | Facility administrator present during the inspection |
| Leslie Ibo | Licensing Program Analyst | Conducted the unannounced case management visit and inspection |
| Harpreet Humpal | Licensing Program Manager | Supervisor overseeing the inspection |
Inspection Report
Monitoring
Census: 92
Capacity: 150
Deficiencies: 0
Sep 20, 2022
Visit Reason
Unannounced case management visit related to infection control follow-up as recommended by local public health.
Findings
The Licensing Program Analyst discussed infection control topics with the Administrator, who stated she will complete all recommendations. No deficiencies were cited.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jeryl Shields | Administrator | Facility Administrator involved in infection control discussion. |
| Leslie Ibo | Licensing Program Analyst | Conducted the unannounced case management visit. |
| Harpreet Humpal | Licensing Program Manager | Named as Licensing Program Manager on the report. |
Inspection Report
Census: 58
Capacity: 150
Deficiencies: 3
Jun 10, 2022
Visit Reason
The visit was an unannounced case management visit conducted due to another visit and involved interview and records review related to an elopement incident.
Findings
The licensee failed to submit an incident report to the licensing agency regarding a resident who eloped from the memory care department and was found in the parking lot. Additionally, an employee (S2) was found to be working without proper association to the facility, violating criminal record clearance requirements.
Severity Breakdown
Type B: 3
Deficiencies (3)
| Description | Severity |
|---|---|
| Resident R1 eloped from memory care and was found in the parking lot by a family member, posing a potential health and safety risk. | Type B |
| Failure to submit a written incident report to the licensing agency within seven days of the occurrence. | Type B |
| Employee S2 was not associated with the facility prior to starting work, violating criminal record clearance requirements. | Type B |
Report Facts
Plan of Correction Due Date: Jun 17, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Leslie Ibo | Licensing Program Analyst | Conducted the case management visit and authored the report |
| Harpreet Humpal | Licensing Program Manager | Supervisor overseeing the inspection |
| Jeryl Shields | Administrator | Facility administrator involved in the incident report discussion |
Inspection Report
Complaint Investigation
Census: 58
Capacity: 150
Deficiencies: 2
Jun 10, 2022
Visit Reason
The inspection was an unannounced complaint investigation visit conducted due to multiple allegations including medication not being administered according to physician's instructions, untrained staff, lack of activities for residents, and insufficient staffing to meet residents' needs.
Findings
The investigation substantiated that medication was administered incorrectly by staff member S3 and that staff member S4 was assisting residents with medications without proper training. The allegation regarding insufficient staffing was unsubstantiated, and the allegation about residents not being provided activities was also unsubstantiated based on observations and interviews.
Complaint Details
The complaint investigation was substantiated for medication errors and untrained staff. The allegation of insufficient staffing was unsubstantiated due to lack of preponderance of evidence. The allegation that residents were not provided activities was unsubstantiated based on observations and resident statements.
Severity Breakdown
Type B: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| S3 administered incorrect dosage of medication to resident R1 and did not follow doctor's orders. | Type B |
| Staff member S4 assisted residents with medications without proper training; no proof of medication training was found. | Type B |
Report Facts
Capacity: 150
Census: 58
Plan of Correction Due Date: Jun 17, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jeryl Shields | Administrator | Named as facility administrator involved in interviews and discussions of findings |
| Leslie Ibo | Licensing Program Analyst | Conducted the complaint investigation visit |
Inspection Report
Capacity: 150
Deficiencies: 0
May 16, 2022
Visit Reason
An unannounced case management visit was conducted for a Component III presentation with the Vice President of Operations and General Manager to review facility operations and readiness for licensing.
Findings
The Licensing Program Analyst reviewed multiple operational areas and found the facility ready to be licensed with no deficiencies cited or observed during the presentation.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jeri Shields | Vice President of Operations | Participated in the Component III presentation during the case management visit. |
| Lydia Hertzler | General Manager | Participated in the Component III presentation during the case management visit. |
| Leslie Ibo | Licensing Program Analyst | Conducted the unannounced case management visit and Component III presentation. |
Inspection Report
Original Licensing
Capacity: 150
Deficiencies: 0
May 16, 2022
Visit Reason
The inspection was an unannounced pre-licensing visit to evaluate the facility prior to licensing approval.
Findings
The facility was found to be clean, in good repair, and compliant with all observed requirements. No deficiencies were cited or observed during the inspection.
Report Facts
Freezer temperature: -7
Refrigerator temperature: 37
Food supply duration: 2
Food supply duration: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jeri Shields | Vice President of Operations | Met during inspection and involved in facility evaluation |
| Lydia Hertzler | General Manager | Met during inspection and involved in facility evaluation |
| Leslie Ibo | Licensing Program Analyst | Conducted the inspection |
| Harpreet Humpal | Licensing Program Manager | Named in report header |
Inspection Report
Original Licensing
Capacity: 150
Deficiencies: 0
May 5, 2022
Visit Reason
Initial licensing inspection conducted via telephone call with the Community Care Licensing Division (CAB) to verify applicant and administrator understanding of Title 22 and facility operation requirements.
Findings
The applicant and administrator successfully completed Component II of the licensing process, demonstrating understanding of facility operation, staff qualifications, training, grievances, complaints, medication management, and application document requirements.
Report Facts
Capacity: 150
Census: 0
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jeryl Shields | Administrator/Managing Member | Participant in COMP II telephone call and applicant/administrator |
| Shannon Betker | Analyst | CAB analyst participating in COMP II telephone call |
| Jude De La Concepcion | Licensing Program Manager | Named in report header and signature section |
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