331881058-11-1-2023-18-AS-JDHS-D5SP7D-20240531110345

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881058
Report Date: 11/01/2023
Date Signed: 11/01/2023 11:47:20 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
03/09/2021 and conducted by Evaluator Yolanda Delgado

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210309144045

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: 29	DATE:	11/01/2023
		ANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Andrea Scott, Administrator		TIME COMPLETED:	11:28 AM

ALLEGATION(S):

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Staff is not able to meet the needs of the residents.
Resident has eloped from the facility.
Residents are not getting their hygiene needs met.
Residents admitted who are not compatible with other residents.
Heater is not working.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Yolanda Delgado met with Administrator at the Riverside Regional Office in order to deliver findings for a complaint investigation into the allegations listed above. During the course of the investigation, LPA interviewed four (4) staff, one (1) resident and one (1) witness. LPA was unable to interview Residents #2, #3 and #4 as they are no longer residing at the facility and LPA was unable to obtain contact with the residents.

On March 9, 2021, Community Care Licensing received a complaint indicating that staff is not able to meet the needs of the residents, residents has eloped from the facility, residents are not getting their hygiene needs met, residents admitted who are not compatible with other residents, heater is not working.
(Continued on Page 2)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Yolanda Delgado	TELEPHONE: (951) 203-2990
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2023

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-20210309144045

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: 11/01/2023

NARRATIVE

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(Continued from Page1)
In regards to the allegation that staff is not able to meet the needs of the residents, it was alleged that facility staff is unable to meet the needs of residents due to staffing concerns. It was reported that one staff member was left alone with up to 23 residents and would issues arose, staff was unable to take action. It was reported that when residents would elope from the facility, staff was unable to shadow the residents due to other residents being left without supervision. Information obtained from staff Interviews and review of the staff schedule revealed one (1) to two (2) staff would be assigned to care for the residents, along with Licensee and Administrator. It was advised that there were no concerns regarding staff levels or if proper care and supervision was being provided.

Regarding the allegation that resident eloped from the facility, it was alleged that Resident #1 and Resident #1 eloped from the facility. It was advised that on multiple occasions, residents eloped. It was reported that staff had to call law enforcement personnel in order to assist with locating residents due to staffing issues. Interviews conducted with staff and residents revealed that R1, R2, and R3 would leave from the facility. LPA was unable to corroborate if residents were allowed to be in the community without supervision due to requested documentation not being provided.

Regarding the allegation that residents are not getting their hygiene needs met, it was alleged that staff was not able to bathe, groom or dress residents. It was reported that staff would unable to provide bathes, grooming, dressing for residents due to not enough time to provide basic care and residents need a podiatrist due to resident’s toenails are long and dirty. Interviews conducted with staff and resident revealed that staff were able to meet the hygiene needs that were assigned. LPA was unable to review documents pertaining to allegation due to information not provided.

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SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Yolanda Delgado	TELEPHONE: (951) 203-2990
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2023

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20210309144045

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: 11/01/2023

NARRATIVE

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(Continued from Page 2)
In regards to the allegation that residents were being admitted to the facility who were not compatible with other residents, it was alleged that Licensee is allowing placement of residents with mental health issues to be admitted. It was reported that Residents who were placed were not compatible with the older residents and were engaging in physical altercations. Interviews conducted with staff and a review of physician reports (R5,R6,R7,R8,R9,R10,R11,R12,R13,R14,R15,R16) reviewed revealed that residents admitted to the facility, did not have aggressive behavior tendencies. It was advised that Licensee conducted proper screenings of residents prior to being admitted to the facility.

In regards to the allegation that the heater is not working, it was alleged the heater in the kitchen and dining room was not working. Interviews conducted with staff and resident stated that the heater was replaced in 2022, the information was corroborated by the Licensee. It was also reported that some residents prefer not to have the heater on. Interviews with resident stated that they were not aware if the heater was working while they were placed at the facility.

In regards to staff not being able to pass out medications to residents, it was alleged that staff is unable to distribute medication to residents due to inadequate staffing levels. Interviews conducted with staff and resident stated that they received their medications without issues. LPA was unable to review documents pertaining to the allegation due to information requested and it was not provided.

Based on information obtained from staff and resident interviews and review of pertinent information regarding the allegations that staff was unable to meet the needs of the residents, resident eloped from the facility, residents are not getting their hygiene needs met, residents are not compatible with other residents, and the heater is not working, may have happened or are valid, there is no preponderance of evidence to prove the alleged violations occurred. Therefore, the allegations is unsubstantiated at this time.

An exit interview was conducted, and a copy of this report was provided along with LIC811 – Confidential Names List.

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Yolanda Delgado	TELEPHONE: (951) 203-2990
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2023

LIC9099 (FAS) - (06/04)

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