331881058-5-9-2022-18-AS-JESL-CHNT65-20220826142635

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881058
Report Date: 05/09/2022
Date Signed: 05/09/2022 11:19:06 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/05/2022 and conducted by Evaluator Crystal Colvin

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20220505155808

FACILITY NAME:	MEADOWBROOK ASSISTED LIVING, LLC		FACILITY NUMBER:	331881058
ADMINISTRATOR:	HAMED, EBRAHEEM		FACILITY TYPE:	740
ADDRESS:	461 E JOHNSTON AVE		TELEPHONE:	(951) 658-8875
CITY:	HEMET	STATE: CA	ZIP CODE:	92543
CAPACITY:	49	CENSUS: 41	DATE:	05/09/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Ebraheem Hamed - Licensee/Administrator		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Staff threatened residents while in care.

Residents not allowed to report to CCL or Ombudsman.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced in order to initiate an investigation of a complaint with the above allegation(s). LPA identified herself and discussed the purpose of the visit and the elements of the allegation(s) with Licensee/Administrator Ebraheem Hamed. Below is a summary of the findings of this complaint:

Regarding allegation "Staff threatened residents while in care": LPA Colvin conducted interviews with 12 of 41 residents during today's inspection. The allegation is in regards to reported statements made by Licensee/Administrator Ebraheem Hamed in a recent meeting with residents. It was reported that residents were threatened for the facility to shut down and the residents not to have a place to go. LPA Colvin was able to confirm that a meeting with the Licensee/Administrator and the residents occurred, but there is not enough evidence to substantiate the claim that the residents were threatened. Accounts of what the Licensee said varied, but the majority of residents interviewed reported that they do not feel as though their housing at the facility is in danger. Therefore, based on interviews and lack of additional evidence, the allegation "Staff

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal Colvin	TELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20220505155808

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: MEADOWBROOK ASSISTED LIVING, LLC	FACILITY NUMBER: 331881058
	VISIT DATE: 05/09/2022

NARRATIVE

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threatened residents while in care." is UNSUBSTANTIATED.

Regarding allegation "Residents not allowed to report to CCL or Ombudsman.": LPA Colvin interviewed residents regarding the allegation, which is also tied to the Licensee/Administrator's recent meeting with the residents. The majority of the responses given to LPA Colvin from residents interviewed is that the Licensee/Administrator encouraged residents to come to him first with their complaints or concerns. The majority of residents denied the allegation that they were specifically told not to communicate or report complaints to other agencies, with some residents stating they were encouraged to do so, and others stating that other agencies were never mentioned. Since accounts what was stated by the Licensee/Administrator vary, and no two stories align in regards to confirming the allegation, the allegation "Residents not allowed to report to CCL or Ombudsman." is UNSUBSTANTIATED.

A finding of UNSUBSTANTIATED means 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.

LPA Colvin recommended to Licensee/Administrator Ebraheem Hamed to assist residents with setting up a Resident Council in order for the residents to assemble together in a place where they feel safe to voice their concerns and then have a designated person report back to the Licensee. This would possibly help mitigate concerns of residents and clear up any additional questions or misunderstandings with communication.

An exit interview was conducted with Licensee/Administrator Ebraheem Hamed and a copy of this report was provided.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal Colvin	TELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2022

LIC9099 (FAS) - (06/04)

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