336413087-7-5-2023-18-AS-JDHS-CY3QZJ-20231130113650

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336413087
Report Date: 07/05/2023
Date Signed: 07/05/2023 03:54:58 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
12/05/2022 and conducted by Evaluator Venus Mixson

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20221205121619

FACILITY NAME:	BROOKDALE MURRIETA		FACILITY NUMBER:	336413087
ADMINISTRATOR:	QUEEN AYERS		FACILITY TYPE:	740
ADDRESS:	24350 JACKSON AVE		TELEPHONE:	(951) 696-5753
CITY:	MURRIETA	STATE: CA	ZIP CODE:	92562
CAPACITY:	82	CENSUS: 62	DATE:	07/05/2023
		UNANNOUNCED	TIME BEGAN:	02:13 PM
MET WITH:	ADMINISTRATOR, QUEEN AYERS		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility staff failed to respond to call button in a timely manner.

INVESTIGATION FINDINGS:

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On July 05, 2023, Licensing Program Analyst (LPA), Venus Mixson
arrived to the facility unannounced to conduct additional staff and resident interviews, and deliver findings to concluded the investigation. LPA Mixson met with the Administrator introduced herself and stated the purpose of the visit.

LPA Mixson toured the facility and made observations pertaining to the listed allegation. Present currently at the facility were 45 staff and 62 residents. There were no deficiencies and/or civil penalties cited per Title 22, Division 6, of the California Code or Regulations during this visit.

The listed allegation was investigated, and based on staff and resident interviews, record reviews and observations, there was not a preponderance of the evidence strand to demonstrate the listed allegation did or did not occur.

On 12/05/2022, Community Care Licensing (CCL), received information stating that the facility staff failed to respond to a residents' call button in a timely manner. Information obtained stated R1 was left in the dining hall and was not picked up by staff and returned to her room. After the LPA's evaluation of the evidence collected, there was not sufficient evidence to show that the alleged allegation actually happened. The record review showed that R1 is an independent resident going to and from the dining room, or community activities. When the LPA interviewed the RP, the information obtained stated that it was a mistake and that it did not occur as it was stated. Staff interviews revealed R1 is independent and does not require assistance going to the dinning room, or anywhere in the community.

Based on this information, the allegation is deem "UNFOUNDED." A finding of UNFOUNDED means that the allegation is false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted and a copy of this report was provided to the Administrator.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Venus Mixson	TELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:	DATE: 07/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2023

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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