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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336426239
Report Date: 07/20/2021
Date Signed: 07/20/2021 03:32:39 PM



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
10/30/2020 and conducted by Evaluator Stephanie Williams
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20201030081423
FACILITY NAME:BROOKDALE SUNWESTFACILITY NUMBER:
336426239
ADMINISTRATOR:SORIANO, MARIAN MFACILITY TYPE:
740
ADDRESS:1085 SUNWEST DRTELEPHONE:
(951) 925-0822
CITY:HEMETSTATE: CAZIP CODE:
92545
CAPACITY:60CENSUS: 28DATE:
07/20/2021
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Theresa WardTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Staff member mishandled resident resulting in injury
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) conducted an unannounced visit to the facility in order to deliver findings for the above allegation. LPA met with Administrator, Theresa Ward, and discussed the purpose of the visit. The investigation consisted of records review and interviews with staff.

LPA interviewed Staff #1 (S1) who stated that the facility conducted an internal investigation of the above allegation. According to S1, on 10/29/2020, Staff #2 (S2) grabbed Resident #1's (R1's) arm after attempting to retrieve Resident #2's (R2's) purse. According to S1, S2's actions resulted in R1 sustaining bruising to the arm. S1 stated that the facility had determined that S2's actions violated facility guidelines for appropriate conduct; therefore, S2 was terminated on 10/31/2020.

Based on the evidence gathered during the course of the investigation, the above allegation is SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation(s) is valid because the preponderance of the evidence standard has been met.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Stephanie WilliamsTELEPHONE: (951) 248-0317
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2021
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-20201030081423
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 SUNWEST
FACILITY NUMBER: 336426239
VISIT DATE: 07/20/2021
NARRATIVE
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An exit interview was conducted where this report was discussed and a copy was provided to Ward.
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Stephanie WilliamsTELEPHONE: (951) 248-0317
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20201030081423
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 SUNWEST
FACILITY NUMBER: 336426239
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/20/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/21/2021
Section Cited
CCR
87468.1(a)(3)
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87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature...This requirement is not met as evidenced by:
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The Administrator agreed to conduct training of Residents Personal Rights for all staff. The Administrator will send proof of training (including topics covered, date of training, and names of attendees) to Department by POC date of 7/21/2021.
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Based on records review and interviews with staff, the Licensee did not ensure that R1 was free from abuse. S2 grabbed R1's arm after taking R2's purse. This resulted in R1's sustaining bruises to the arm. This is an immediate health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Stephanie WilliamsTELEPHONE: (951) 248-0317
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3