336410691-6-15-2023-18-AS-NBRN-CT3NN2-20230623103601

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336410691
Report Date: 06/15/2023
Date Signed: 06/15/2023 10:46:19 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
05/03/2021 and conducted by Evaluator Anna Bueno

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210503144834

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: 126	DATE:	06/15/2023
		UNANNOUNCED	TIME BEGAN:	09:48 AM
MET WITH:	Denise Flores, Executive Director		TIME COMPLETED:	10:48 AM

ALLEGATION(S):

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Staff inappropriately touched a resident while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Anna Bueno conducted a subsequent unannounced visit to the facility to continue the complaint investigation and deliver findings on the above allegations. LPA met with executive director (ED) Denise Flores who was informed of the purpose of today’s visit. The investigation consisted of staff and resident interviews and review of relevant records.

LPA was unable to corroborate the allegation that Staff 1 (S1) inappropriately touched Resident 1(R1). Interview with R1 stated that they do not know who touched them, where they were touched, or how they were grabbed. During the interview with Department staff, R1 was not aware of current events, current date, and personal information about themselves due to their cognitive condition. Department staff interviewed facility staff who stated that S1 has worked at the facility for 10 years. Interview with S1 denied they inappropriately touched R1 or any residents. S1 stated that R1 needed prompting during showers, toileting, and grooming but R1 mostly will not remember how to use grooming and shower items or how to dress themselves. Interviews conducted with S1, R1, and facility staff revealed there were no witnesses to corroborate the mentioned allegation.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 248-0339
LICENSING EVALUATOR NAME: Anna Bueno	TELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2023

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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Control Number 18-AS-20210503144834

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: BROOKDALE MIRAGE INN	FACILITY NUMBER: 336410691
	VISIT DATE: 06/15/2023

NARRATIVE

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Based on the information obtained during this investigation, the above allegations are therefore unsubstantiated. A finding that the allegations are UNSUBSTANTIATED means that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted where this report was discussed and provided to ED Flores.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 248-0339
LICENSING EVALUATOR NAME: Anna Bueno	TELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2023

LIC9099 (FAS) - (06/04)

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