361881034-4-28-2022-56-AS-KCLS-CVTQKU-20230919121455

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361881034
Report Date: 04/28/2022
Date Signed: 04/28/2022 12:12:07 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
04/22/2022 and conducted by Evaluator Javier Prieto

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20220422115858

FACILITY NAME:	BROOKDALE LOMA LINDA		FACILITY NUMBER:	361881034
ADMINISTRATOR:	ADAMS, LUCINDA		FACILITY TYPE:	740
ADDRESS:	25585 VAN LEUVEN STREET		TELEPHONE:	(909) 796-5421
CITY:	LOMA LINDA	STATE: CA	ZIP CODE:	92354
CAPACITY:	220	CENSUS: 119	DATE:	04/28/2022
		UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Jennifer Larson		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Insufficient staffing to meet residents needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to conduct a complaint investigation regarding allegations that there is insufficient staff to meet the residents needs. LPA Prieto met with Jennifer Larsen who states that there are sufficient staff to meet the needs of the residents and provided LPA Prieto with staffing rosters and schedules to reflect their duties in the care of residents. Jennifer also states that residents with specific needs are additionally addressed with assistance of Home Health and Hospice agencies. Resident's responsible parties are communicated with as to the going care of the residents.

Based on the information obtained there is not enough evidence that there is insufficient staffing to meet the resident's needs. Therefore, the allegation is deemed unsubstantiated at this time. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Javier Prieto	TELEPHONE: 951-217-3135
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2022

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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