331881058-11-10-2022-18-AS-JESL-CNL28N-20230130161036

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881058
Report Date: 11/10/2022
Date Signed: 11/10/2022 03:56:29 PM

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
11/04/2022 and conducted by Evaluator Crystal Colvin

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20221104131258

FACILITY NAME:	MEADOWBROOK ASSISTED LIVING, LLC		FACILITY NUMBER:	331881058
ADMINISTRATOR:	SHALABI, JAMAL		FACILITY TYPE:	740
ADDRESS:	461 E JOHNSTON AVE		TELEPHONE:	(951) 658-8875
CITY:	HEMET	STATE: CA	ZIP CODE:	92543
CAPACITY:	49	CENSUS: 35	DATE:	11/10/2022
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Andrea Scott - Administrator		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility staff did not ensure that residents had an adequate food supply

Facility staff did not ensure that residents had eating utensils

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 Administrator Andrea Scott. Below is a summary of the findings of this complaint:

Regarding allegation "Facility staff did not ensure that residents had an adequate food supply": LPA Colvin toured the facility and examined the facility's supply of perishable and non-perishable food. LPA Colvin observed that in addition to the regular food in rotation for the facility staff to use to cook with, the facility additionally had two large crates labled as "3 month emergency food supply". LPA Colvin additionally interviewed staff and residents at the facility regarding the allegation, specifically about the facility running out of food over a recent weekend and staff having to scrape together food or purchase more with their own money. The majority of interviews conducted denied that there is ever an issue with the supply of food at the facility, though it was reported that some residents are not happy with the meals that are being served.

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: 11/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2022

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-20221104131258

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: 11/10/2022

NARRATIVE

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LPA Colvin was present at the facility during serving of lunch, and LPA Colvin observed that the food being served was both plentiful in the quantity that was being prepared for the residents, and also matched the posted facility menu for the week (burrito with side of beans). LPA Colvin inquired with staff and residents about facility's ability to provide additional food upon request of resident, and it was relayed that there are always alternatives for residents to eat (and can have for additional servings), but that there might not be more of what was specifically prepared for that meal. Due to lack of evidence to support the allegation and the majority of interviews denying lack of food, the allegation "Facility staff did not ensure that residents had an adequate food supply" is UNSUBSTANTIATED.

Regarding allegation "Facility staff did not ensure that residents had eating utensils": LPA Colvin toured the facility's kitchen and observed both plastic utensils and silverware present in the kitchen. LPA Colvin additionally observed plastic forks set out for the residents during serving of lunch. LPA Colvin conducted interviews with staff and residents at the facility regarding the allegation. Statements obtained during interviews were conflicting, with some reporting the facility running out of plastic forks, some reporting no issue, and some reporting running out of plastic utensils but silverware still available for use. Due to lack of evidence to support the allegation and percentage of conflicting interviews, the allegation "Facility staff did not ensure that residents had eating utensils" 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.

An exit interview was conducted with Administrator Andrea Scott 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: 11/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2022

LIC9099 (FAS) - (06/04)

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