336426434-10-4-2022-56-AS-EMAN-CK7PH5-20221014111923

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426434
Report Date: 10/04/2022
Date Signed: 10/04/2022 12:11:09 PM

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
, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/29/2022 and conducted by Evaluator Ryan Gardner

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20220929085916

FACILITY NAME:	BROOKDALE CORONA		FACILITY NUMBER:	336426434
ADMINISTRATOR:	MARITZA LUJAN		FACILITY TYPE:	740
ADDRESS:	2005 KELLOGG AVE		TELEPHONE:	(951) 898-6991
CITY:	CORONA	STATE: CA	ZIP CODE:	92879
CAPACITY:	60	CENSUS: 48	DATE:	10/04/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Jennifer Sanchez Lazaro- Business Office Cooordinator		TIME COMPLETED:	12:20 PM

ALLEGATION(S):

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Staff do not provide proper food service to residents in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ryan Gardner arrived at the facility unannounced to initiate and deliver findings for the above complaint allegation. LPA met with Business Office Coordinator Jennifer Sanchez-Lazaro and explained the reason for the visit.

During today’s visit, LPA toured the facility, conducted interviews with residents, conducted interviews with staff, and reviewed facility documentation.

For allegation, Staff do not provide proper food service to residents in care:

During document review, the staff provided LPA with the breakfast, lunch, snack, and dinner menu for September and October. The menu has a variety of food groups such as: protein, dairy, vegetables, and fruits. LPA was informed that breakfast is served at 8:30 am, lunch is served at 12pm, and dinner is served at 5pm. LPA found that snacks are served at 10 am and 3pm. The residents can request additional food at any other time during the day if they are hungry outside of the serving times.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2022

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 56-AS-20220929085916

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
, CA 92507

FACILITY NAME: BROOKDALE CORONA	FACILITY NUMBER: 336426434
	VISIT DATE: 10/04/2022

NARRATIVE

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During interviews with residents and staff, LPA found that the residents are being served three meals a day, along with snacks. LPA was informed that the meals are good in quantity and in taste. LPA was informed that residents are served quickly, residents are not waiting long periods of time to receive their meals, and the meals are delivered to the residents at the correct temperature.

Based on information found and discovered, LPA found that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed UNSUBSTANTIATED.

An exit interview was conducted, and this report was discussed and provided to Business Office Coordinator Jennifer Sanchez-Lazaro, along with a copy of the appeal rights.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2022

LIC9099 (FAS) - (06/04)

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