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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374600735
Report Date: 02/09/2023
Date Signed: 02/09/2023 10:22:08 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 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
08/29/2022 and conducted by Evaluator Nacole Patterson
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20220829114950
FACILITY NAME:BROOKDALE CLAIREMONTFACILITY NUMBER:
374600735
ADMINISTRATOR:PIERFAX, JUDITHFACILITY TYPE:
740
ADDRESS:5219 CLAIREMONT MESA BLVDTELEPHONE:
(858) 292-8044
CITY:SAN DIEGOSTATE: CAZIP CODE:
92117
CAPACITY:214CENSUS: 80DATE:
02/09/2023
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Candi Laird, Executive DirectorTIME COMPLETED:
10:25 AM
ALLEGATION(S):
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Staff not providing resident medication as prescribed.
Licensee did not provide residents(s) safe/comfortable accommodations.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced complaint visit to the facility to deliver findings for the above allegations. LPA introduced herself and disclosed the purpose of the visit to Candi Laird, Executive Director.

On 8/29/22 it was alleged that staff were not providing a resident medication as it was prescribed, and that Licensee did not provide resident(s) safe and/or comfortable accommodations. The Department’s investigation consisted of unannounced facility tours, review of facility and outside source records, interviews with facility staff and outside sources, and LPA direct observations.

(Continued on LIC9099-C...)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Nacole PattersonTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023
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 2
Control Number 08-AS-20220829114950
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: BROOKDALE CLAIREMONT
FACILITY NUMBER: 374600735
VISIT DATE: 02/09/2023
NARRATIVE
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...Continued from LIC9099
Regarding the first allegation, “Staff not providing resident medication as prescribed”, the Department found that facility staff were adhering and administering prescriptions to residents according to the amount, prescription types and dates, as prescribed by their physicians. Residents interviewed stated that they were being given their medications accurately and did not disclose any medication errors or mismanagement by facility staff. Records reviewed revealed no medication errors during the time of concern. The medications prescribed to the resident in question were administered according to the prescription dosage by two different Medication Technicians. Outside source interviews revealed no concerns or reports regarding medication errors or medication mismanagement at the facility.

Regarding the second allegation, “Licensee did not provide resident(s) safe/comfortable accommodations” due to their response to a facility flood. Outside source interviews, records review, and resident interviews showed that the first indication of a flood was on 8/25/22 at 8:00am, when a facility staff observed wet carpet outside of a resident’s room. The source of the water was found to be from a toilet that had been flushed with non-flushable items, backing up the main water line. On 8/25/22 Facility staff began relocating residents as maintenance extracted the water and sanitized the affected areas. The Administrator contacted the assigned LPA via voicemail on 8/27/22, notifying that the flood had occurred at the facility and that the affected residents were being relocated to different rooms. Outside source records and interviews as well as facility records show that a restoration company was contracted on 8/25/22 and began assessing the damage the same day. On 8/31/22 the Department conducted a Case Management visit and was informed of each area of the facility that was impacted by the flood. The facility provided a list of relocation for each resident and advised that personal belongings left in the rooms were being evaluated for damage. Residents were relocated in phases starting on 8/25/22 based on the proximity to the flood origin location. The restoration included demolition, debris clean-up, plumbing, cleaning and deodorizing carpets, baseboard replacement, drywall repair, sealing/priming walls, painting, and countertop re-installation. 15 resident rooms, 5 offices, 2 common restrooms, and 7 corridors/storage rooms sustained flood damage. The facility restoration was completed in the beginning of December 2022. Residents interviewed stated that the facility responded to the flood right away and the time in which they were relocated was appropriate and reasonable. Although the Department received slightly inconsistent information regarding dates of service, there is not sufficient evidence to support that the facility did not respond timely to ensure residents’ health and safety during the flood incident.

Based on interviews, direct LPA observations and records review, a preponderance of evidence does not exist to prove that the alleged violation(s) occurred, therefore both allegations are therefore UNSUBSTANTIATED. An exit interview was conducted with Candi Laird, Executive Director, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) were provided.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Nacole PattersonTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023
LIC9099 (FAS) - (06/04)
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