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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881058
Report Date: 09/07/2022
Date Signed: 09/07/2022 04:41:28 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
08/31/2022 and conducted by Evaluator Janira Arreola
COMPLAINT CONTROL NUMBER: 18-AS-20220831171608
FACILITY NAME:MEADOWBROOK ASSISTED LIVING, LLCFACILITY NUMBER:
331881058
ADMINISTRATOR:SHALABI, JAMALFACILITY TYPE:
740
ADDRESS:461 E JOHNSTON AVETELEPHONE:
(951) 658-8875
CITY:HEMETSTATE: CAZIP CODE:
92543
CAPACITY:49CENSUS: 35DATE:
09/07/2022
UNANNOUNCEDTIME BEGAN:
12:30 AM
MET WITH:Staff, Andrea ScottTIME COMPLETED:
04:50 PM
ALLEGATION(S):
1
2
3
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5
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7
8
9
Staff fed resident spoiled food.
INVESTIGATION FINDINGS:
1
2
3
4
5
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7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Janira Arreola made an unannounced visit to the facility for the purpose of a complaint investigation. LPA met with Andrea Scott who was informed of the purpose of the visit.

LPA gathered resident files, and other pertinent documents. LPA conducted file review, interviews, and documented observations. Concerning the allegation "Staff fed resident spoiled food" LPA conducted interviews with staff and residents. (3) out of (9) resident interviews indicated that residents had been fed food that taste spoiled. LPA conducted a walk through of the facility and went through food in kitchen pantry and refrigerators. LPA found (10) bottles of dressing that were expired. These items were sealed and had not been given to the residents and were discharded immediately by staff. Staff reported that pantry and refrigerators are cleaned on a weekly basis. LPA reviewed this on staff duties posted at facility. LPA observed the staff serving lunch to the residents and observed that these items did not look or smell spoiled.

Based on the fact that LPA cannot assert that expired food items found would be served to residents, and considering LPA cannot confirm food residents are stating tasted spoiled was indeed spoiled. LPA cannot coroborate the allegation that residents were fed spoiled foods. Therefore the allegation is unsubstantiated. A finding of unsubstantiated means that although the allegation is valid, the proponderance of the evidence standard has not been met.

An exit intervuew was conducted where this report was reviewed and provided to staff, Andrea Scott.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira ArreolaTELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:

DATE: 09/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2022
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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