336426434-5-17-2023-18-AS-NBRN-CS6UE2-20230525153027

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426434
Report Date: 05/17/2023
Date Signed: 05/17/2023 03:13:07 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
03/25/2021 and conducted by Evaluator Amy Goldenberg

COMPLAINT CONTROL NUMBER: 18-AS-20210325120129

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: 38	DATE:	05/17/2023
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Brittney Martinez, Executive Director		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff are not providing access to a resident's records

INVESTIGATION FINDINGS:

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This unannounced visit by Amy Goldenberg, Licensing Program Analyst (LPA), is being conducted to conclude this agency’s investigation into the complaint allegation mentioned above. During the course of this investigation LPA obtained and reviewed the following documentation: Identification and Emergency Information form (LIC 601) and Durable Power of Attorney (POA) paperwork for resident (R1). It is alleged that a person was requesting on behalf of R1 copies of their documentation from the facility. Review of POA paperwork indicated that R1 had appointed individuals designated on the POA. The party that was requesting R1's records was not an appointed individual on R1's POA. The facility did not have a release of information signed by the person appointed on the POA allowing the requesting party access to R1's records according to Administrator Maritza Lujan, and the paperwork could not be released at that time. Review of facility records did not reveal any court order, subpoenas for R1's records until 11/15/2021 and on 01/12/2022. Documentation was provided verifying the documents were provided. Based on the information available at this time, we have found the complaint allegation is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred as reported. A copy of this report is being reviewed with and furnished to the facility representative.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Amy Goldenberg	TELEPHONE: (951) 201-3990
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023

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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