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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881631
Report Date: 10/13/2025
Date Signed: 10/13/2025 11:03:22 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 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
05/20/2025 and conducted by Evaluator Armando Perez
COMPLAINT CONTROL NUMBER: 18-AS-20250520150021
FACILITY NAME:MEADOWBROOK PLACE ASSISTED LIVINGFACILITY NUMBER:
331881631
ADMINISTRATOR:SCOTT, ANDREAFACILITY TYPE:
740
ADDRESS:461 E JOHNSTON AVENUETELEPHONE:
(818) 470-6457
CITY:HEMETSTATE: CAZIP CODE:
92543
CAPACITY:49CENSUS: 18DATE:
10/13/2025
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Administrator Andrea ScottTIME COMPLETED:
11:10 AM
ALLEGATION(S):
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Staff do not ensure hot water can be accessed throughout the facility to residents
Staff do not provide residents with snacks between meals
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Armando Perez, conducted an unannounced visit to deliver findings for a complaint investigation regarding the above allegations. LPA Perez met with Administrator Andrea Scott, where the LPA explained the purpose of the visit and the elements of the allegation. The investigation consisted of interviews with staff and witnesses, and file reviews.

On May 20, 2025, Community Care Licensing Division (CCLD) received a complaint alleging that staff do not ensure hot water can be accessed throughout the facility to residents and staff do not provide residents with snacks between meals.

In response to the allegation that staff failed to ensure residents had consistent access to hot water throughout the facility, it was reported that hot water was unavailable during nighttime hours and on weekends.
Continued on LIC 9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Armando Perez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2025
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 3
Control Number 18-AS-20250520150021
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: MEADOWBROOK PLACE ASSISTED LIVING
FACILITY NUMBER: 331881631
VISIT DATE: 10/13/2025
NARRATIVE
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During a visit to the facility, Additional Witness 1 (AW1) reported interviewing multiple residents and information obtained revealed ongoing issues with hot water availability in Building 2. Through interview with Administrator Andrea Scott, information revealed that Building 2 had a malfunctioning water heater and confirmed the issue initially reported on March 21, 2025. Interview with Staff 1 (S1) revealed they believed the problem had appeared to be resolved, however, S1 noted the water heater began malfunctioning again after a few days. Interviews with 7 out of 9 residents corroborated that Building 2 experienced persistent lack of hot water issues, resulting in residents needing to shower in Building 1. A review of facility records confirmed that a new water heater was purchased and installed on May 27, 2025. Additionally, a review of incident records revealed no documentation indicating that Community Care Licensing Division had been notified of the water heater issue as required by regulation.

In response to the allegation that staff do not provide residents with snacks between meals, it was reported that snacks and beverages are consistently unavailable during those times. Interview with AW1 revealed multiple residents reported concerns of the lack of snack availability between meals. AW1 also noted during multiple visits to the facility, they did not observe any snacks being available or offered to residents. Information obtained through Interview with Administrator revealed facility staff provides snacks daily noting they are stored in the kitchen pantry of Building 2. Administrator added that while the snack offering is consistent, some residents decline the snacks and most do not actively request them. Interview with 9 out 9 residents contradicted Administrators statement and corroborated that snacks between meals are not offered consistently or at all. Through file review, food menus were reviewed and observed to not include snack information. Additionally, LPA could not obtain clear information if a snack procedure is implemented. LPA toured the kitchen and documented the presence of snack items stored in the pantry. LPA noted that the snacks were limited in both quantity and quality.

Based on interviews, record reviews, and observations, the allegation that staff do not ensure hot water can be accessed throughout the facility to residents and staff do not provide residents with snacks between meals is Substantiated. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. The facility will be cited.

An exit interview was conducted. A copy of this report was provided to Administrator Andrea Scott, along with a copy of the LIC9099-C, LIC9099D, and Appeal Rights were provided.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Armando Perez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20250520150021
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: MEADOWBROOK PLACE ASSISTED LIVING
FACILITY NUMBER: 331881631
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/13/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/13/2025
Section Cited
CCR
87303(a)
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87303Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met as evidenced by:
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The facility purchased a hot water heater on May 27, 2025. Heater has been installed, no further concerns with unit.
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Based on staff, resident interviews and record reviews, the Licensee did not comply with the above regulation with not repairing the water heater in a timely manner resulting in the lack of consistent hot water for residents in care.
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Type B
11/03/2025
Section Cited
CCR
87555(b)(3)
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87555 General Food Service Requirements (b) The following food service requirements shall apply: (3) Between-meal nourishment or snacks shall be made available for all residents unless…prescribed by a physician. This requirement was not met as evidenced by:
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The Administrator will revise the facility menus to include daily snacks that are accessible to residents and will develop a formal snack policy. Administrator will provide in-house training with all staff to acknowledge and implement the new snack provisions.
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Based on resident interviews and record reviews showing lack of proof that snacks are consistently provided between meals. This poses a potential health risk to residents in care.
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Copies of the updated menus will be emailed to the LPA with the proof of training by the POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Armando Perez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3