366402583-9-2-2021-18-AS-KCLS-C85U75-20211025151919

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366402583
Report Date: 09/02/2021
Date Signed: 09/02/2021 02:44:27 PM

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
09/02/2021 and conducted by Evaluator Javier Prieto

COMPLAINT CONTROL NUMBER: 18-AS-20210902092629

FACILITY NAME:	BROOKDALE NORTH EUCLID		FACILITY NUMBER:	366402583
ADMINISTRATOR:	LISA TO		FACILITY TYPE:	740
ADDRESS:	1031 N EUCLID AVE		TELEPHONE:	(909) 391-2622
CITY:	ONTARIO	STATE: CA	ZIP CODE:	91762
CAPACITY:	140	CENSUS: 88	DATE:	09/02/2021
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Marco Ramos		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff are not emptying residents urinal

Staff are not making residents bed

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to concluded complaint investigation regarding allegations that staff are not emptying residents urinal and staff are not making residents bed. LPA Prieto met with Business Manager Marco Ramos and Executive Director Lisa To. LPA obtained service plan from staff and interviewed resident #1 (R1) in question. R1 states that staff does empty the portable urinal and staff does make the resident's bed. R1 states that calls will not be made to Licensing as staff are responsive to any of R1's concerns. R1 states that family members are also attentive. R1 states the emptying of the urinal and making of bed was R1's choice, but staff does perform those services when they are called upon.

Based on the information obtained there is not enough evidence that staff are not emptying residents urinal and staff are not making residents bed. Therefore, the allegations are 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, therefore the allegation is UNSUBSTANTIATED.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javier Prieto	TELEPHONE: 951-217-3135
LICENSING EVALUATOR SIGNATURE:	DATE: 09/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021

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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