331881058-9-4-2024-18-AS-TDAN-D8TPP4-20240905112853

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881058
Report Date: 09/07/2022
Date Signed: 09/04/2024 11:50:55 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
08/29/2022 and conducted by Evaluator Janira Arreola

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20220829163723

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:	09/07/2022
		UNANNOUNCED	TIME BEGAN:	12:30 AM
MET WITH:	Staff, Andrea Scott		TIME COMPLETED:	04:40 PM

ALLEGATION(S):

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Staff forced resident to eat food from the trash

INVESTIGATION FINDINGS:

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The following is an amended report:
Licensing Program Analyst (LPA) Janira Arreola made an unannounced visit to the facility for the purpose of a complaint investigation. LPA met with Staff, 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 forced resident to eat food from the trash". LPA interview staff and asked about resident involved in allegation, staff stated there was no such resident by that name living at the facility. LPA asked for the register of residents, LPA observed resident files being stored in office cabinet and confirmed there were not residents by the name reported.
LPA interviewed staff and residents and found that none had witnessed staff forcing any resident to eat from a trash can. LPA found through resident interviews that some residents do eat from trash cans or will pick up used cigarettes to smoke from the floor. LPA did not find any evidence to corroborate that staff forced a resident to eat from the trash can. LPA observed that facility residents were provided with snacks, and LPA observed facility serving lunch to residents.

Based on this information the allegation is unsubstantiated. A finding of unsubstantiated means that although the allegation is valid, there is no evidence to suggest that the allegation did occur.

An exit interview was conducted where this report was reviewed and provided to staff, Andrea Scott.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tricia Danielson	TELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira Arreola	TELEPHONE: 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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