361881034-4-10-2023-56-AS-KCLS-CRYVE9-20230519162155

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361881034
Report Date: 04/10/2023
Date Signed: 04/10/2023 12:33:56 PM

Unsubstantiated

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
04/06/2023 and conducted by Evaluator Magda Malcore

COMPLAINT CONTROL NUMBER: 56-AS-20230406114326

FACILITY NAME:	BROOKDALE LOMA LINDA		FACILITY NUMBER:	361881034
ADMINISTRATOR:	LUJAN, MARITZA		FACILITY TYPE:	740
ADDRESS:	25585 VAN LEUVEN STREET		TELEPHONE:	(909) 796-5421
CITY:	LOMA LINDA	STATE: CA	ZIP CODE:	92354
CAPACITY:	220	CENSUS: 109	DATE:	04/10/2023
		UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Maritza Lujan, Administrator		TIME COMPLETED:	12:35 PM

ALLEGATION(S):

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Licensee does not adequately staff facility to meet resident needs
Staff yell at residents
Staff do not maintain the facility in clean and sanitary condition
Staff do not bathe/shower residents

INVESTIGATION FINDINGS:

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On 4/10/23, Licensing Program Analyst (LPA) Magda Malcore made an unannounced visit to the facility to conduct a complaint investigation regarding the above allegations. LPA Malcore met with Office Manager, Ashley Fife and discussed the purpose of the visit. Administrator, Maritza Lujan arrived at the facility shortly after and LPA discussed the purpose of the visit. During the investigation, LPA toured the facility, obtained relevant documents, interviewed staff, and residents.

Regarding the allegation, Licensee does not adequately staff facility to meet resident needs, All staff interviewed deny that the Licensee does not adequately staff facility to meet resident needs. All residents interviewed deny that the Licensee does not adequately staff facility to meet resident needs. Staff interviews and documentation reveal that the facility documents which residents need bathroom and incontinence care to ensure that the residents personal needs are met. LPA did not encounter a resident with complaints of not being assisted with diaper changes.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Magda Malcore	TELEPHONE: 951-248-0316
LICENSING EVALUATOR SIGNATURE:	DATE: 04/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2023

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 56-AS-20230406114326

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 LOMA LINDA	FACILITY NUMBER: 361881034
	VISIT DATE: 04/10/2023

NARRATIVE

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Regarding the allegation, staff yell at residents, All staff interviewed deny yelling at residents nor witnessed staff yelling at residents. Four (4) out of (5) residents interviewed deny that staff have yelled at them nor witnessed staff yell at residents.

Regarding the allegation, staff do not maintain the facility in clean and sanitary condition, LPA toured the facility and observed that floors are maintained in a clean, odorless condition, and in good repair. Interviews with staff and document review reveal that the facility is cleaned daily and carpet cleaning is conducted weekly.

Regarding the allegation, staff do not bathe/shower residents, All staff interviewed deny not bathing/showering residents. All residents interviewed deny not being bathe/showered. Staff interviews and documentation reveal that residents have a weekly shower schedule. The shower schedule notates the following: name of residents, schedule day and time of day of showers. If a resident refuses bathing/showering, a refusal slip is filed out, notating the reason for not accepting bathing assistance.

Based on evidence obtained during the investigation, the above allegations are Unsubstantiated; While the allegations may have happened or may be valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. No deficiencies were cited at this time

An exit interview was conducted where this report was discussed, and a copy of this report was provided to Administrator, Maritza Lujan, at the conclusion of the visit.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Magda Malcore	TELEPHONE: 951-248-0316
LICENSING EVALUATOR SIGNATURE:	DATE: 04/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2023

LIC9099 (FAS) - (06/04)

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