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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336426511
Report Date: 05/26/2021
Date Signed: 07/08/2021 10:04:29 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
12/23/2020 and conducted by Evaluator Pauline Beschorner
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20201223164714
FACILITY NAME:BROOKDALE MAGNOLIAFACILITY NUMBER:
336426511
ADMINISTRATOR:SARAH DEVOREFACILITY TYPE:
740
ADDRESS:737 MAGNOLIA AVETELEPHONE:
(951) 737-1600
CITY:CORONASTATE: CAZIP CODE:
92879
CAPACITY:180CENSUS: 113DATE:
05/26/2021
UNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Monique Del JuncoTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Food Service is inadequate.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Pauline Beschorner conducted an unannounced complaint visit in order to deliver findings for the above complaint allegation. LPA met with Executive Director Monique Del Junco.

It was alleged the food served was not edible and had to be thrown out on multiple occasions. LPA interviewed residents and toured the kitchen. Interviews with residents revealed varying answers. Of the residents interviewed, 4 of 6 revealed the food service was adequate and the residents enjoy the food offered. Food is stored at appropriate temperatures and no food was observed past their expiration dates. Menus are posted to advise individuals of what is being served and an alternative is provided if they do not want to eat the meal being served. Residents tend to not tell the staff the food provided was inedible and did not request an alternative. Therefore, LPA is unable to corroborate that the food served was inedible and had to be thrown out.

Although the above-mentioned allegation may have happened there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED at this time.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Pauline BeschornerTELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2021
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 2
Control Number 18-AS-20201223164714
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
RIVERSIDE, CA 92507
FACILITY NAME: BROOKDALE MAGNOLIA
FACILITY NUMBER: 336426511
VISIT DATE: 05/26/2021
NARRATIVE
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An exit interview was conducted and a copy of this report was reviewed with and provided to Executive Director Monique Del Junco..
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Pauline BeschornerTELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2