331881058-5-2-2022-18-AS-DMUN-CEDTZW-20220513151101

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881058
Report Date: 05/02/2022
Date Signed: 05/02/2022 03:16:58 PM

Unfounded

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
10/28/2021 and conducted by Evaluator Tricia Danielson

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20211028105828

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: 39	DATE:	05/02/2022
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Linda Speller, Caregiver Liliana Alvarez, Med Tech		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Residents are neglected
Faciltiy has run out of supplies to clean the residents
Accommodations are not safe.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tricia Danielson arrived unannounced to the facility to conclude an investigation into the allegations listed above. LPA met with Med Tech Liliana Alvarez and Caregiver Linda Speller and explained the purpose of the visit.
Regarding the allegations "Residents are neglected", "Facility has run out of supplies to clean the residents", and "Accommodations are not safe" and after interview with the Reporting Party (RP), it was determined that the allegations do not pertain to the facility. RP clarified the allegations pertain to a health care center of a similar name and on the same property. This agency has investigated the complaint alleging "Residents are neglected", "Facility has run out of supplies to clean the residents", and "Accommodations are not safe".
We have found that the complaint was unfounded, meaning that the allegations were false, could not have happened and are without a reasonable basis. We have therefore dismissed the complaint.
An exit interview was conducted with Speller and a copy of this report was provided.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Tricia Danielson	TELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2022

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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