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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336426434
Report Date: 12/23/2020
Date Signed: 12/23/2020 05:05:37 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
12/18/2020 and conducted by Evaluator Natalie Gayoso
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20201218152034
FACILITY NAME:BROOKDALE CORONAFACILITY NUMBER:
336426434
ADMINISTRATOR:MARITZA LUJANFACILITY TYPE:
740
ADDRESS:2005 KELLOGG AVETELEPHONE:
(951) 898-6991
CITY:CORONASTATE: CAZIP CODE:
92879
CAPACITY:60CENSUS: 37DATE:
12/23/2020
UNANNOUNCEDTIME BEGAN:
03:38 PM
MET WITH:Maritza LujanTIME COMPLETED:
04:52 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Food Service is inadequate.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Natalie Gayoso contacted the facility via telephone to commence a complaint investigation due to COVID-19. LPA identified herself and discussed the purpose of the call and the elements of the allegation with administrator Maritza Lujan.

During this investigation, LPA conducted interviews with Reporting Party and administrator. LPA found that this complaint was issued under the wrong facility name. This agency has investigated the complaint allegation. 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. We have therefore dismissed the complaint.

No deficiencies were cited at this time. An exit interview was conducted, and a copy of this report was reviewed via telephone and provided to the administrator via email.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Natalie GayosoTELEPHONE: (951) 290-1102
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2020
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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