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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366426055
Report Date: 08/25/2022
Date Signed: 08/25/2022 12:50:26 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
08/17/2022 and conducted by Evaluator Anna Bueno
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20220817151703
FACILITY NAME:BRIGHTWATER SENIOR LIVING OF HIGHLAND (DBA)FACILITY NUMBER:
366426055
ADMINISTRATOR:MARGUERITE CROCKEMFACILITY TYPE:
740
ADDRESS:28807 BASELINE STREETTELEPHONE:
(909) 742-7353
CITY:HIGHLANDSTATE: CAZIP CODE:
92346
CAPACITY:115CENSUS: DATE:
08/25/2022
UNANNOUNCEDTIME BEGAN:
10:14 AM
MET WITH:Marguerite Crockem, Executive DirectorTIME COMPLETED:
12:53 PM
ALLEGATION(S):
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Staff served resident an eviction letter containing incorrect information
Staff did not provide resident with reappraisal
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 on the above allegation. LPA identified herself to executive director Marguerite Crockem, who was notified of the reason for today’s visit.

Allegation 1: The allegation is that staff served resident (R1) an eviction letter containing incorrect information. On 8/1/2022, this facility sent a copy of R1's eviction letter copy to the Department with the Long-Term Care Ombudsman's phone number as (909)891-3928 and the Department's number as (951)248-2222.
Allegation 2: Staff did not provide resident with reappraisal. Records review show that R1 physian's report was completed on 8/30/21, a facility history and physical report was updated on 4/30/22, and the quarterly service plan was completed on 7/12/22.

Based on the available information, we have found the complaint allegation is UNFOUNDED. **************continued on LIC 9099-C**************
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Anna BuenoTELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
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
08/17/2022 and conducted by Evaluator Anna Bueno
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20220817151703

FACILITY NAME:BRIGHTWATER SENIOR LIVING OF HIGHLAND (DBA)FACILITY NUMBER:
366426055
ADMINISTRATOR:MARGUERITE CROCKEMFACILITY TYPE:
740
ADDRESS:28807 BASELINE STREETTELEPHONE:
(909) 742-7353
CITY:HIGHLANDSTATE: CAZIP CODE:
92346
CAPACITY:115CENSUS: DATE:
08/25/2022
UNANNOUNCEDTIME BEGAN:
10:14 AM
MET WITH:Marguerite Crocken, Executive DirectorTIME COMPLETED:
12:53 PM
ALLEGATION(S):
1
2
3
4
5
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7
8
9
Staff interfere with resident obtaining medical care
INVESTIGATION FINDINGS:
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3
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5
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12
13
Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced visit to the facility to commence a complaint investigation and deliver findings on the above allegation. LPA identified herself to executive director Marguerite Crockem, who was notified of the reason for today’s visit.

The allegation is: Staff interfere with resident (R1) obtaining medical care. Records review showed that the facility has been in communication with R1 medical office. Records revealed that the facility received R1's medication order changes following R1's aggression incidents, specifically, two days after an episode from 5 weeks ago and same day after an episode four weeks ago. Staff interviews also reveal that San Bernardino Fire Department was contacted regarding R1 situation but the agency determined non-emergency services were appropriate. Interviews reveal that R1 refused medical services. This allegation is therefore 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 where this report (LIC 9099) was discussed, and a copy provided to the Executive Director.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Anna BuenoTELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 56-AS-20220817151703
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: BRIGHTWATER SENIOR LIVING OF HIGHLAND (DBA)
FACILITY NUMBER: 366426055
VISIT DATE: 08/25/2022
NARRATIVE
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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 the Executive Director.
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Anna BuenoTELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3