336426511-10-14-2020-18-AS-EMAN-BUTUMR-20201028154248

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426511
Report Date: 10/14/2020
Date Signed: 10/14/2020 10:34:39 AM

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
09/02/2020 and conducted by Evaluator Robbie Johnson

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200902113658

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: 137	DATE:	10/14/2020
		UNANNOUNCED	TIME BEGAN:	09:32 AM
MET WITH:	Mary Mcclure, Administrator		TIME COMPLETED:	10:33 AM

ALLEGATION(S):

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Facility failed to provide resident adequate nutrition

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Robbie Johnson contacted the facility via telephone to deliver findings regarding the above allegation via telephone due to COVID-19. LPA identified herself and discussed the purpose of the call and the elements of the above allegation with Administrator Mary Mcclure.

During the course of the investigation, LPA conducted interviews with staff, residents and reviewed facility menus dated March 1, 2020 through September 1, 2020. Interviews with staff revealed that residents are offered at least two food choices with each meal. Staff interviews revealed that the facility regularly offers sugar free food options, fruit trays, and vegetables with each meal. Interviews with several residents revealed that the facility meals have adequate nutrition and the facility will accommodate residents with special diets. A review of the facility's menu revealed a variety of entree options for breakfast, lunch and dinner along with vegetable, salad and reduced sugar dessert options. LPA could not corroborate that the facility does not provide adequate nutrition to residents. The allegation is therefore, UNSUBSTANTIATED. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged abuse occurred. A copy of this report was reviewed with and provided to the Administrator.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Robbie Johnson	TELEPHONE: (951) 248-0304
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2020

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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