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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336412146
Report Date: 11/15/2022
Date Signed: 11/15/2022 12:00:55 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
12/11/2020 and conducted by Evaluator Tricia Danielson
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20201211141309
FACILITY NAME:MEADOWBROOK SENIOR LIVINGFACILITY NUMBER:
336412146
ADMINISTRATOR:JOHANNA LAGANDAONFACILITY TYPE:
740
ADDRESS:461 E JOHNSTON AVETELEPHONE:
(951) 658-6374
CITY:HEMETSTATE: CAZIP CODE:
92543
CAPACITY:0CENSUS: 0DATE:
11/15/2022
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Staff and designee not available, facility closed 3/18/2021TIME COMPLETED:
10:45 AM
ALLEGATION(S):
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Resident is being financially abused while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tricia Danielson phoned designee Johanna Lagandaon in an effort to deliver findings of an investigation into the allegation listed above. LPA was unable to make contact with Lagandaon and althought LPA requested a return call, one was not received.
Regarding the allegation "Resident is being financially abused while in care", it was alleged that Resident #1 (R1) was being asked to pay additional fees other than those agreed upon at admission. It was also alleged that R1's bank card was being kept from them and that facility administration was aware of R1's PIN number. Through interviews conducted, the investigation revealed R1 signed an admission agreement and agreed to pay $1100 per month to reside at the facility. However, R1 only paid approximately $900 per month and after two months, they were asked for an additional $200 per month as agreed upon. R1 verified their signature on the Admission Agreement. R1 retained possession of their bank card and PIN number and did not share the PIN with anyone else. Also, R1 paid all fees through cash. Seven (7) of eleven (11) residents interviewed and whom resided at the facility during R1's residency denied being financially abused. This agency has investigated the complaint alleging "Resident is being (CONTINUED ON LIC9099-C)
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Tricia DanielsonTELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2022
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 2
Control Number 18-AS-20201211141309
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: MEADOWBROOK SENIOR LIVING
FACILITY NUMBER: 336412146
VISIT DATE: 11/15/2022
NARRATIVE
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(CONTINUED FROM LIC9099)
financially abused while in care". We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

An exit interview was not able to be conducted however, a copy of this report along with LIC811- Confidential Names List was sent via email to Lagandaon via email at MHCCADMISSIONS@gmail.com.
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Tricia DanielsonTELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2