361881034-9-15-2022-56-AS-NBRN-CJYTBA-20221007143450

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361881034
Report Date: 09/15/2022
Date Signed: 09/15/2022 02:00:26 PM

Unfounded

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
09/09/2022 and conducted by Evaluator Anna Bueno

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20220909121934

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: 111	DATE:	09/15/2022
		UNANNOUNCED	TIME BEGAN:	10:34 AM
MET WITH:	Maritza Lujan, Administrator		TIME COMPLETED:	02:02 PM

ALLEGATION(S):

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Staff do not communicate with resident's responsible party

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced visit to the facility to commence a complaint investigation and deliver findings. LPA identified herself to Administrator Maritza Lujan who was notified of the reason for today’s visit. LPA discussed the purpose of the visit and the elements of the allegation. The investigation included staff and resident interviews and records review.

It is alleged that Staff do not communicate with resident's responsible party. Interview with responsible party and staff confirmed that this facility calls resident's emergency contacts for unsusual incidents, specifically for changes in medications and/or changes in condition and needs and services. LPA reviewed records and found that resident is self-responsible.

Based on the available information, we have found the complaint allegation is UNFOUNDED. A finding of unfounded means that the allegation is false, could not have happened and/or is without a reasonable basis. An exit interview was conducted where this report was discussed and a copy provided to Administrator Lujan.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Anna Bueno	TELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022

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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