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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881095
Report Date: 03/21/2023
Date Signed: 03/21/2023 03:28:11 PM

Substantiated


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
01/26/2022 and conducted by Evaluator Javina George
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20220126075930
FACILITY NAME:LINDEN AT MURRIETA, THEFACILITY NUMBER:
331881095
ADMINISTRATOR:MATTHEW MURPHYFACILITY TYPE:
740
ADDRESS:27100 CLINTON KEITH ROADTELEPHONE:
(951) 477-5678
CITY:MURRIETASTATE: CAZIP CODE:
92562
CAPACITY:137CENSUS: 110DATE:
03/21/2023
UNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Karen Lovett, Business Office ManagerTIME COMPLETED:
03:40 PM
ALLEGATION(S):
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Facility did not provide resident transportation to medical appointments.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to deliver findings for the allegation(s) listed above. LPA met with Karen Lovett Businness Office Manager, and explained the purpose of the visit. The investigation consisted of observation, interviews, and record review.

A review of documentation revealed that there was a discussion had between R1’s responsible party and the previous Administrator Matthew Murphy of transportation relating to R1 and their dialysis appointments in the city of Perris three times a week, prior to R1 moving into the facility. The documentation revealed that someone from the front desk, told R1s responsible party that transportation would in fact be provided. However, additional documentation revealed that R1 had to pay a private company so that they could be transported to their dialysis appointments. The previous Administrator Matthew did state that the wrong information was provided and that there would be a credit issued for $504.00 to R1s rent to cover the expenses for private transportation being utilized.
***Continued on 9099c
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 6
Control Number 18-AS-20220126075930
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: LINDEN AT MURRIETA, THE
FACILITY NUMBER: 331881095
VISIT DATE: 03/21/2023
NARRATIVE
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The current Administrator Billy Tames stated that the facility does provide transportation, and that it is normally for offices located in Murrieta, or within a 10-mile radius for medical and dental appointments, and that anything outside the ten miles is up to the discretion of the General Manager. The transportation days for Doctor’s and dental appointments are on (Mondays, Tuesdays, Thursdays) and shopping on (Wednesdays and Fridays). The transportation schedule reviewed has a note that states that “any other transportation on these days will be a $10.00 charge each way.

A review of R1s signed monthly fee states that scheduled transportation is to be provided. It is not specified that extra fees will incur or that the office should be within a 10-mile radius. In addition, the facility does not have the transportation program in writing stating that the location to where transportation is needed should be in Murrieta and within a 10-mile radius, and that anything outside is up to the discretion of the General Manager. Therefore, the allegation of facility did not provide resident transportation to medical appointments is SUBSTANTIATED.

An exit interview was conducted and a copy of this report, 9099D, LIC 811 (confidential names list) and appeal rights were provided to Karen Lovett, Business Office Manager.

SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 18-AS-20220126075930
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: LINDEN AT MURRIETA, THE
FACILITY NUMBER: 331881095
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/04/2023
Section Cited
CCR
87208(a)(8)
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87208 Operating requirements
(a) Each facility shall have and maintain a current, written definitive plan of operation. The plan and related materials shall be on file in the facility and shall be submitted to the licensing agency with the license application. Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. The plan and related materials shall contain the following:
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The licensee agrees to have a written transportation procedure. POC is due by 5pm on the due date indicated.
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(8) Transportation arrangements for persons served who do not have independent arrangements. This requirement is not met as evidenced by: R1 was led to believe transportation would be provided to their dialysis appointments. However due to the location being outside of Murrieta, R1s transportation request was denied, forcing them to utilize a private transportation company, This poses a potential health, safety and personal rights risk to persons in care
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 6
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
01/26/2022 and conducted by Evaluator Javina George
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20220126075930

FACILITY NAME:LINDEN AT MURRIETA, THEFACILITY NUMBER:
331881095
ADMINISTRATOR:MATTHEW MURPHYFACILITY TYPE:
740
ADDRESS:27100 CLINTON KEITH ROADTELEPHONE:
(951) 477-5678
CITY:MURRIETASTATE: CAZIP CODE:
92562
CAPACITY:137CENSUS: 110DATE:
03/21/2023
UNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Karen Lovett, Business Office Manager TIME COMPLETED:
03:40 PM
ALLEGATION(S):
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Resident fell several times while in care resulting in injuries.
Responsible party was not provided with details of resident’s move to memory care.
Facility did not provide resident a proper bed.
Resident was not given proper notice of price increases.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to deliver findings for the allegation(s) listed above. LPA met with Kelly Lovett, Business Office Manager and explained the purpose of the visit. The investigation consisted of observation, interviews, and record review.

Resident fell several times while in care resulting in injuries.
Documentation reviewed revealed that R1 did in fact have several falls. Some of the falls occurred on the following days: September 19, 2021-R1 lost their footing fell and resulted in a Rib contusion. On September 29, 2021-unwitnessed fall resulting in being sent out and diagnosed with a chest bruise. October 5, 2021-R1 tripped and landed on their right knee, no complaints of pain or discomfort. November 4, 2021-R1 fell out of the bed, had shoulder pain, sent out for evaluation. November 10, 2021-R1 R1 reported that they were adjusting themselves, said they slid off of the couch and fell. Resulting in a fractured left humerus and on November 13, 2021-unwitnessed fall. *** Continued on 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 18-AS-20220126075930
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: LINDEN AT MURRIETA, THE
FACILITY NUMBER: 331881095
VISIT DATE: 03/21/2023
NARRATIVE
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R1 stated that lost their footing and as they were falling, they pulled on the tubing in their chest out. Additional documentation reviewed revealed that R1 was admitted to the facility and noted in R1s service agreement that R1 presents a moderate risk for falls due to their medications, ambulatory status and history of dizziness, and that a plan to reduce the falls should be identified. In addition, on October 1, 2021, the facility’s LVN made a request for R1 to get started on physical therapy due to the number of falls that they experienced since moving into the facility. It further states that two of the four falls resulted R1 having to go to the hospital and that there is a concern for R1’s safety. Based on observation and record review the allegation is UNSUBSTANTIATED.

Responsible party was not provided with details of resident’s move to memory care.
Resident #1 (R1) was admitted to the facility on July 12, 2021 on the assisted living side of the community. Documentation reviewed revealed that R1’s responsible party did inquire prior to R1 being moving into the facility what moving from assisted living to memory care involved such as fees associated with the additional care that was to be provided. A review of documentation revealed that R1s responsible party was not notified that R1 required an increase in care until October 28, 2021. It was noted that a reassessment of R1s needs was completed and that R1 required additional care going from AL-level 1 to AL level 2. It was also noted that the facility back dated the date the additional services were provided, which was on October 8, 2021. However, there was no mention of it until October 28, 2021 to R1’s responsible party. Even though the facility did not inform R1’s responsible party at the time that they began providing R1 with additional services, R1 did not move into the memory care unit until November 11, 2021. In addition, documentation reviewed noted for R1s responsible party to be on agreement with R1s move to the memory care unit, Additionally, R1 was diagnosed with having dementia on November 13, 2021 when they were sent out to the emergency room after sustaining a fall.and that there was a previous discussion of fees associated with moving into memory care. Therefore, the allegation is UNSUBSTANTIATED.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 18-AS-20220126075930
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: LINDEN AT MURRIETA, THE
FACILITY NUMBER: 331881095
VISIT DATE: 03/21/2023
NARRATIVE
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Resident was not given proper notice of price increases.

Regarding the allegation resident was not given proper notice of price increases. LPA reviewed a letter addressed to R1 dated November 1, 2021 informing R1 that that facility completed a review of operational expenses that includes food, staffing ratios and other provided services, R1s monthly apartment fee will increase to $3,125 per month effective January 1, 2022. R1 was given a sixty (60) day notice about the increase in their rent, as well as their responsible party. The allegation of resident was not given proper notice of price increases is UNSUBSTANTIATED.

Facility did not provide resident a proper bed.

It was alleged that the facility provided R1 a cot to sleep on after they were discharged from the hospital with a broken humerus. Documentation reviewed dated November 16, 2021 reveals that the Memory Care Director Michelle DeFierra did inform R1’s responsible party that R1s bed would not be able to fit into the new room in the memory care unit. However, there was no further discussion of what would happen next, if R1 would in fact move into the room selected or if a different bed would be provided. It was reported that only a twin-size bed would fit into the room. R1 was provided with a roll away twin size bed the allegation of facility did not provide resident a proper bed is UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means that 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 and a copy of this report was provided to Karen Lovett, Business Office Manager.

SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2023
LIC9099 (FAS) - (06/04)
Page: 6 of 6