366409010-10-5-2021-18-AS-EMAN-C86NJF-20211026103017

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366409010
Report Date: 10/05/2021
Date Signed: 10/05/2021 03:38:08 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
12/31/2020 and conducted by Evaluator Natalie Gayoso

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20201231113530

FACILITY NAME:	BROOKDALE LOMA LINDA		FACILITY NUMBER:	366409010
ADMINISTRATOR:	LUCINDA ADAMS		FACILITY TYPE:	740
ADDRESS:	25585 VAN LEUVEN ST		TELEPHONE:	(909) 796-5421
CITY:	LOMA LINDA	STATE: CA	ZIP CODE:	92354
CAPACITY:	0	CENSUS: 115	DATE:	10/05/2021
		UNANNOUNCED	TIME BEGAN:	03:31 PM
MET WITH:	Gregg Bernhard		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Resident's room was not cleaned
Staff stole resident's personal belongings

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Natalie Gayoso conducted an in office meeting to deliver findings for the above allegations. LPA introduced herself and explained the purpose of today’s meeting with Administrator, Gregg Bernhard.

The investigation consisted of interviews with pertinent parties. The first allegation indicated resident’s room was not clean. Interviews with staff indicated that the room Resident 1 (R1) was moved into temporarily, while their original room was being renovated, was clean. R1 nor their family member had ever mentioned the room was not clean when R1 moved in. Staff 4 (S4) stated that the temporary room R1 was placed in had just been renovated, was clean, and no one had lived in the room since renovations were completed.

The second allegation indicates staff stole resident’s personal belongings. Interviews with staff stated when R1 moved into the facility R1 did not bring any crystal lamps with them. Interview with Staff 1 (S1)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Natalie Gayoso	TELEPHONE: (951) 290-1102
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2021

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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Control Number 18-AS-20201231113530

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
RIVERSIDE, CA 92507

FACILITY NAME: BROOKDALE LOMA LINDA	FACILITY NUMBER: 366409010
	VISIT DATE: 10/05/2021

NARRATIVE

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and Staff 2 (S2) stated they were informed by the moving company that R1 had informed the movers to donate a crystal lamp. Staff also stated they have never witnessed staff at the facility steal or take any of R1’s belongings including clothing. Interview with moving company stated R1 had 2 crystal lamps when they went to pick up and move R1’s belongings. R1 informed the movers to donate both lamps due not having enough room and not wanting them anymore. Movers stated 1 lamp was donated and the other was thrown away due to being broken.

Based on interviews, the allegations are UNSUBSTANTIATED. A finding of Unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted, and a copy of this report was provided to the Administrator

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Natalie Gayoso	TELEPHONE: (951) 290-1102
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2021

LIC9099 (FAS) - (06/04)

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