336426511-1-9-2023-18-AS-EMAN-CMZ227-20230111160013

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426511
Report Date: 01/09/2023
Date Signed: 01/09/2023 11:53:07 AM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
08/10/2020 and conducted by Evaluator Ryan Gardner

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200810113759

FACILITY NAME:	BROOKDALE MAGNOLIA		FACILITY NUMBER:	336426511
ADMINISTRATOR:	SARAH DEVORE		FACILITY TYPE:	740
ADDRESS:	737 MAGNOLIA AVE		TELEPHONE:	(951) 737-1600
CITY:	CORONA	STATE: CA	ZIP CODE:	92879
CAPACITY:	180	CENSUS: 124	DATE:	01/09/2023
		UNANNOUNCED	TIME BEGAN:	11:34 AM
MET WITH:	Blasia-Lee Lole		TIME COMPLETED:	12:02 PM

ALLEGATION(S):

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Resident was under the influence of drugs while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ryan Gardner made an unannounced visit to the facility to conclude and issue findings for the investigation that was initiated on 08/18/2020. LPA stated the purpose of the visit and was granted entry and met with Administrator Blasia-Lee Lole.

For allegation, Resident was under the influence of drugs while in care:

The investigation was conducted by IB Investigator Brittany Hudec which included a review of Resident R1’s facility and medical records, interviews conducted with the R1’s family, interviews conducted with facility staff, and an interview conducted with R1.

Based on interviews conducted, and information, and evidence obtained, the IB Investigator found that R1 was not under the influence of drugs while in care. R1 tested positive for Amphetamines and Cannabinoids at the hospital lab test on 8/3/2020.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2023

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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Control Number 18-AS-20200810113759

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: BROOKDALE MAGNOLIA	FACILITY NUMBER: 336426511
	VISIT DATE: 01/09/2023

NARRATIVE

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During a second test at the hospital lab on 8/5/2020, R1 tested negative for Amphetamines and Cannabinoids. It was noted by the physician that if Amphetamines and Cannabinoids were in R1’s system on 8/3/2020 the Amphetamines and Cannabinoids would still be present on hospital lab test on 8/5/2020. It was found that there was either a mix up at the hospital lab and or a false positive was read on the initial lab result at the hospital due to this the investigation is deemed UNFOUNDED.

A finding that the complaint is UNFOUNDED means that the allegation was without a reasonable basis. Therefore, the above allegation is dismissed.

During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report was discussed and provided to Administrator Blasia-Lee Lole, along with a copy of the appeal rights.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2023

LIC9099 (FAS) - (06/04)

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