374600735-6-28-2022-08-AS-DPOL-CGSSKG-20220729135643

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374600735
Report Date: 06/28/2022
Date Signed: 06/28/2022 12:13:34 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, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/22/2021 and conducted by Evaluator Esther Miller

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20211222095604

FACILITY NAME:	BROOKDALE CLAIREMONT		FACILITY NUMBER:	374600735
ADMINISTRATOR:	PIERFAX, JUDITH		FACILITY TYPE:	740
ADDRESS:	5219 CLAIREMONT MESA BLVD		TELEPHONE:	(858) 292-8044
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92117
CAPACITY:	214	CENSUS: 93	DATE:	06/28/2022
		UNANNOUNCED	TIME BEGAN:	09:27 AM
MET WITH:	Kelly Roberts, Executive Director		TIME COMPLETED:	11:47 AM

ALLEGATION(S):

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Licensee did not facilitate virtual visits.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Esther Miller conducted an unannounced complaint investigation visit to the facility in order to conduct interviews and deliver findings on the above allegation. LPA was granted entry to the facility by Kelly Roberts, Executive Director, after identifying herself and shared the findings of the investigation.

On December 12, 2021, it was alleged that the facility did not facilitate virtual visits for Resident 1 (R1). More specifically, it was alleged that staff were not printing emails and reading them to R1. The Department’s investigation consisted of review of facility records and interviews of facility staff and outside sources.

[Continued on LIC9099-C]

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Esther Miller	TELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2022

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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Control Number 08-AS-20211222095604

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: BROOKDALE CLAIREMONT	FACILITY NUMBER: 374600735
	VISIT DATE: 06/28/2022

NARRATIVE

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According to facility records, R1 was diagnosed with mild cognitive impairment (MCI), indicating that R1 was alert, oriented, and could communicate needs. Outside source interviews also confirmed that R1 is alert and oriented. Facility’s visitation logs revealed that R1 was visited frequently by family members. Interviews with R1, an outside source, and staff denied the allegation and corroborated that the facility facilitated visitation.

Outside source interviews revealed that R1 had made statements about preferring in person visits, instead of communicating over the phone or internet. R1 stated that they had an iPhone that they knew how to use. LPA also observed that the facility did provide a computer with internet access and also access to a printer. R1 stated they had knowledge of the facility computer but did not use it. Outside source records also revealed that R1 had communicated clearly to family members and staff how and when they wished to have visits. R1 expressed that they visit with family via FaceTime and in person as well. R1 had expressed with multiple outside sources whom they did and did not want visits from. Title 22, Chapter 8, section 87468.2(a)(21) allows residents to consent to visitors of their choosing.

Based on the evidence obtained during the complaint investigation, the allegation that the licensee did not facilitate virtual visits is found to be UNSUBSTANTIATED, meaning that although the allegation may have happened or may be valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with Executive Director; a copy of this report and Licensee's Rights (LIC9058) were provided to Executive Director.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Esther Miller	TELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2022

LIC9099 (FAS) - (06/04)

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