361881034-2-28-2023-56-AS-KCLS-CPKTU2-20230303140137

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361881034
Report Date: 02/28/2023
Date Signed: 02/28/2023 02:01:37 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
02/23/2023 and conducted by Evaluator Bernadette Allen

COMPLAINT CONTROL NUMBER: 56-AS-20230223163022

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: 104	DATE:	02/28/2023
		UNANNOUNCED	TIME BEGAN:	11:40 AM
MET WITH:	Maritza Lujan- Adminstrator		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Facility freezer is in disrepair.
Staff not washing hands.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bernadette Allen an conducted an unannounced visit to initiate and deliver findings for the allegations above. LPA met with Maritza Lujuan and disclosed the nature of the alleged allegations.

#1 Allegation- Facility Freezer is in disrepair- LPA investigation consisted of interviews with eight (8) staff members who stated that the refrigerators and freezers have been in working condition and has not been out of order. Maritza Lujuan also provided documents pertaining to maintenance service/repair which was last conducted back in August 2022. LPA toured the kitchen, walk-in freezer (Temp -4 ), and walk-in refrigerator(Temp 32 degrees) and they are in working condition.

#2 Allegation- LPA investigation consisted of interviews with eight (8) staff members who stated staff members are required to wash their hands while working in the kitchen/dining area and that they have not noticed other staff members not washing their hands.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Bernadette Allen	TELEPHONE: 951-897-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2023

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-20230223163022

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
, CA 92507

FACILITY NAME: BROOKDALE LOMA LINDA	FACILITY NUMBER: 361881034
	VISIT DATE: 02/28/2023

NARRATIVE

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LPA also obtained current training documents for the month of February 2023 that show staff members are aware of their dietary and dining services requirements. During the investigation LPA also observed that staff members were continuously washing their hands.

Based on observations, interviews, and documentation the above finding is Unsubstantiated. A finding of unsubstantiated means although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Bernadette Allen	TELEPHONE: 951-897-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2023

LIC9099 (FAS) - (06/04)

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