<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374600735
Report Date: 04/20/2023
Date Signed: 04/20/2023 05:28:40 PM

Substantiated


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
01/10/2023 and conducted by Evaluator Sabel Martinez
COMPLAINT CONTROL NUMBER: 08-AS-20230110152610
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: 82DATE:
04/20/2023
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Executive Director, Candi LairdTIME COMPLETED:
05:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not meet a resident's incontinence needs
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA), Sabel Martinez, conducted an unannounced complaint investigation visit to condcut additional interviews and deliver findings. The LPA introduced himself and disclosed the purpose of the visit to Administrator Candi Laird.

Throughout the investigation, the Department secured pertinent records and conducted interviews with internal and external sources.

It was alleged staff did not meet a resident's incontinence needs. A source reported a resident requested assistance with incontinence care and staff did not assist until approximately one hour had passed. Interviews with internal sources corroborated there had been multiple occasions where residents had waited over an hour before staff assisted with incontinent care. Although a review of records obtained at the facility and interviews contradicted the accuracy of the pendant response logs, the preponderance of evidence standard was met, therefore, the allegation was Substantiated. (See LIC 9099C for continuation of report.)
Substantiated
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (610) 767-2317
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023
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 3
Control Number 08-AS-20230110152610
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: 04/20/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The deficiency was cited in accordance with California Code of Regulations Title 22 and listed on the LIC 9099D. A plan of correction was jointly formulated with Executive Director Candi Laird.

An exit interview was conducted with Executive Director, Candi Laird, to whom a copy of this report, LIC 9099D and Licensee/Appeals Rights (LIC 9058) were provided via electronic mail. An electronic mail read receipt confirms the documents were received.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (610) 767-2317
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20230110152610
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/20/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/20/2023
Section Cited
CCR
87625(b)(3)
1
2
3
4
5
6
7
87625 Managed Incontinence (b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Administrator agreed to provided incontionence management training to caregivers and medication techs, by 5/19/2023.
8
9
10
11
12
13
14
Based on interviews, the licensee did not ensure multiple incontinent residents were kept clean and dry, which posed a potential health, safety and personal rights risk to 5 of 82 residents in care.
8
9
10
11
12
13
14
Administrator agreed to submit proof of conducted traininig and attendees, by 5/19/2023
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (610) 767-2317
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3