<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336426434
Report Date: 03/19/2025
Date Signed: 03/19/2025 01:46:22 PM

Substantiated


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
02/23/2024 and conducted by Evaluator Melody Brown
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240223104649
FACILITY NAME:BROOKDALE CORONAFACILITY NUMBER:
336426434
ADMINISTRATOR:BRITTNEY MARTINEZFACILITY TYPE:
740
ADDRESS:2005 KELLOGG AVETELEPHONE:
(951) 898-6991
CITY:CORONASTATE: CAZIP CODE:
92879
CAPACITY:60CENSUS: 44DATE:
03/19/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:District Director of Clinical Services Sheryl Hendricks, RN, and Executive Director Brittney Martinez, LVNTIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not treat resident with dignity or respect.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 03/19/2025 at 01:00 PM, Licensing Program Analyst (LPA), Melody Brown, met with District Director of Clinical Services Sheryl Hendricks, RN, and Executive Director (ED) Brittney Martinez, LVN at Community Care Licensing Division (CCLD) Adult and Senior Care (ASC) San Bernardino (SB) Regional Office to deliver the findings of the above allegation. LPA Brown explained the purpose of the requested Office Visit. The investigation consisted of file review, interviews with residents and staffs as well as observation.

The investigation of the allegation was conducted by LPAs Melody Brown and Ryan Gardner. The investigation consisted of file review and interviews with relevant parties. The allegation indicates that staff did not treat resident with dignity or respect. During LPAs Brown and Gardner's investigation, it was indicated that Staff #6 (S6) does not like Resident #1 (R1) and does not have patience for R1 that resulted to R1's increased agitation. In addition, Staff #1 (S1) informed LPA Brown that S6 was suspended on 01/02/2024 for reporting an incident inaccurately and S6 was terminated on 01/18/2024 ***Continuation in LIC9099C***
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025
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 6
Control Number 56-AS-20240223104649
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: 03/19/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
after they conducted a thorough investigation following S6's suspension as R1's integrity's at risk and for the concerns noted in accurate reporting on the reported 01/01/2024 incident at the facility. S1 provided LPA Brown copies of S6's Corrective Actions and their Incident Investigation. LPAs Brown and Gardner were able to obtain evidence to corroborate that S6 did not treat R1 with dignity or respect.

The allegation staff did not treat resident with dignity or respect is found to be SUBSTANTIATED. A deficiency is being issued per California Code of Regulations (CCR), Title 22. A substantiated finding means that the allegation staff did not treat resident with dignity or respect is valid because the preponderance of evidence standard has been met.

An exit interview was conducted where this report, LIC9099, LIC9099D, and Appeal Rights were discussed and provided to District Director of Clinical Services Sheryl Hendricks, RN, and ED Brittney Martinez, LVN.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 56-AS-20240223104649
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/19/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/28/2025
Section Cited
CCR
87568.1(a)(1)
1
2
3
4
5
6
7
87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have...(1) To be accorded dignity in their personal relationships with staff, residents...This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee stated that S6's employment was terminated on 01/18/2024.
Licensee stated to train all staff on CCR 87468.1(a)(1) and submit proof of all staff training log to LPA Brown by the Plan of Correction (POC) due date.
8
9
10
11
12
13
14
Based on interview and records review, the Licensee did not comply with the section cited above by not ensuring that Staff #6 (S6) treat Resident #1 (R1) with dignity or respect which poses a potential health, safety and personal rights risk to resident in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 6
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
02/23/2024 and conducted by Evaluator Melody Brown
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240223104649

FACILITY NAME:BROOKDALE CORONAFACILITY NUMBER:
336426434
ADMINISTRATOR:BRITTNEY MARTINEZFACILITY TYPE:
740
ADDRESS:2005 KELLOGG AVETELEPHONE:
(951) 898-6991
CITY:CORONASTATE: CAZIP CODE:
92879
CAPACITY:60CENSUS: 44DATE:
03/19/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:District Director of Clinical Services Sheryl Hendricks, RN, and Executive Director Brittney MartinezTIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident #1 (R1) suffered a broken elbow and a torn rotator cuff during a behavior incident due to staff neglect.
Staff did not meet the needs of residents in care.
Staff illegally evicted resident.
Staff did not refund fees according to resident's Admission Agreement.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 03/19/2025 at 01:00 PM, Licensing Program Analyst (LPA), Melody Brown, met with District Director of Clinical Services Sheryl Hendricks, RN, and Executive Director (ED) Brittney Martinez, LVN at Community Care Licensing Division (CCLD) Adult and Senior Care (ASC) San Bernardino (SB) Regional Office to deliver the findings of the above allegations. LPA Brown explained the purpose of the requested Office Visit. The investigation consisted of file review, interviews with residents and staffs as well as observation.

First allegation: Resident #1 (R1) suffered a broken elbow and a torn rotator cuff during a behavior incident due to staff neglect. The investigation of the first allegation was conducted by Department staff. The investigation consisted of file review and interviews with relevant parties. The allegation indicates Resident #1 (R1) suffered a broken elbow and a torn rotator cuff during a behavior incident due to staff neglect. During the Department staff investigation, it was indicated that Staff #6 (S6) denied failing to intervene when Resident #1 (R1) confronted and punched Resident #2 (R2). Department staff interviews with facility management, caregivers and S6 revealed that ***Continuation in LIC9099C***
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 56-AS-20240223104649
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: 03/19/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
it cannot be conclusively established when and where R1’s injuries occurred and therefore cannot be shown that R1’s injuries were a result of staff neglect. Department staff interviews with other staffs cannot corroborate that S6 somehow failed to act or otherwise intervene during R1’s behaviors.

Second allegation: Staff did not meet the needs of residents in care. The investigation was conducted by LPAs Melody Brown and Ryan Gardner which consisted of file review, observation and interviews with relevant parties. During the investigation, LPAs Brown and Gardner were not able to obtain sufficient evidence to support that staff did not meet the needs of residents in care. LPAs Brown and Gardner interviewed six (6) residents and six (6) of six (6) residents residents indicated that staffs at the facility are meeting their needs as they are providing care and supervision to them, checking on them multiple times in a day and they promptly assist them if needed. Interview with seven (7) of seven (7) staffs indicated that they are meeting the needs of the residents at the facility daily as they are checking on them every one (1) hour or every two (2) hours if they need assistance, to keep their incontinent residents clean and dry and to ensure the residents safety. Seven (7) of seven (7) staffs interviewed stated that they are provided monthly training to ensure that they are providing appropriate care and supervision to all their residents. During the facility visit on 12/05/2024, and 03/04/2025, LPA Brown observed staffs at the facility are checking on their residents and providing care and supervision.

Third allegation: Staff illegally evicted resident. The investigation was conducted by LPAs Melody Brown and Ryan Gardner which consisted of records review and interviews with relevant parties. The third allegation indicates that staff illegally evicted resident. During the investigation, LPAs Brown and Gardner were not able to obtain sufficient evidence to corroborate the allegation. Interview with Staff #1 (S1) indicated that R1 was given 30 days Eviction Notice on 12/27/2023 as it has been determined that R1 has a need not previously identified that requires a higher level of care than what the facility can provide. During the facility visit on 12/05/2024, S1 provided LPA Brown a copy of 30-Day Notice and proof of delivery sent to R1 family/Responsible Person.

Fourth allegation: Staff did not refund fees according to resident's Admission Agreement. The investigation was conducted by LPAs Melody Brown and Ryan Gardner which consisted of file review, observation and interviews with relevant parties. During the investigation, LPAs Brown and Gardner were not able to obtain sufficient evidence to support that staff did not refund fees ***Continuation in LIC9099C***
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 56-AS-20240223104649
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: 03/19/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
according to resident's Admission Agreement. Interview with Staff #1 (S1) indicated that R1's family/Responsible Person was refunded $1,200.00 which is 40% of the community fee as $500.00 of the Community Fee becomes non-refundable due to R1 completing the Pre-Admission Appraisal (Personal Service Assessment). Documents review indicated that community fee's $3,500.00 and LPA Brown noted that R1 has a completed Pre-Admission Appraisal (Personal Service Assessment) which makes the $500.00 non-refundable and 40% of the community fee less the $500.00 non-refundable is $1,200.00.

Therefore, based on the evidence obtained during the Department staff, LPAs Brown and Gardner's investigation, there is insufficient evidence to prove that Resident #1 (R1) suffered a broken elbow and a torn rotator cuff during a behavior incident due to staff neglect (Allegation #1), staff did not meet the needs of residents in care (Allegation #2), staff illegally evicted resident (Allegation #3) and staff did not refund fees according to resident's Admission Agreement (Allegation #4) are UNSUBSTANTIATED at this time. Although the allegations of Resident #1 (R1) suffered a broken elbow and a torn rotator cuff during a behavior incident due to staff neglect (Allegation #1), staff did not meet the needs of residents in care (Allegation #2), staff illegally evicted resident (Allegation #3) and staff did not refund fees according to resident's Admission Agreement (Allegation #4) may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED at this time.

An exit interview was conducted where this report (LIC9099), was discussed and provided to District Director of Clinical Services Sheryl Hendricks, RN, and ED Brittney Martinez, LVN.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 6