336410691-6-20-2021-18-AS-NBRN-C4JLMJ-20210702085245

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336410691
Report Date: 06/14/2021
Date Signed: 06/20/2021 02:04:16 AM

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
09/19/2019 and conducted by Evaluator Shaunte Henry

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20190919101655

FACILITY NAME:	BROOKDALE MIRAGE INN		FACILITY NUMBER:	336410691
ADMINISTRATOR:	SPAUN, JOHN		FACILITY TYPE:	740
ADDRESS:	72750 COUNTRY CLUB DR		TELEPHONE:	(760) 346-7772
CITY:	RANCHO MIRAGE	STATE: CA	ZIP CODE:	92270
CAPACITY:	145	CENSUS:	DATE:	06/14/2021
		UNANNOUNCED	TIME BEGAN:	02:04 PM
MET WITH:	Jessalette Castro, Business Office Manager.		TIME COMPLETED:	02:19 PM

ALLEGATION(S):

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Staff mishandled resident resulting in bruising

INVESTIGATION FINDINGS:

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On 6/15/21 Licensing Program Analysts (LPA)s Shaunte Henry and Anna Bueno conducted an unannounced visit for the purpose of delivering the finding to the above allegation. LPAs met Jessalette Castro explained the nature of the visit and was granted entry into the facility.

The investigation, which consisted of interviews and record review revealed the following: Staff 1 (S1) denied mishandling Resident 1 (R1) that resulted in bruising in September of 2019. S2 was present with both S1 and R1 and did not witness S1 mishandling R1. S2 did not observe bruising on R1. R1 stated that S1 handled S1 rough, however R1 did not recall sustaining bruising from the encounter. Due to conflicting information, the LPA was unable to corroborate the allegation that "staff mishandled resident resulting in bruising. Brookdale Mirage Inn staff investigated the complaint and found the allegation to be unsubstantiated. 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, therefore the allegation is UNSUBSTANTIATED at this time. An exit interview was conducted where this report was discussed with and provided to Jessalette Castro.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Shaunte Henry	TELEPHONE: (951) 217-0236
LICENSING EVALUATOR SIGNATURE:	DATE: 06/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2021

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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