374600735-4-13-2023-08-AS-LTEZ-CRBURU-20230428154915

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374600735
Report Date: 04/13/2023
Date Signed: 04/13/2023 02:01:24 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
09/01/2022 and conducted by Evaluator Sabel Martinez

COMPLAINT CONTROL NUMBER: 08-AS-20220901163543

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: 81	DATE:	04/13/2023
		UNANNOUNCED	TIME BEGAN:	01:42 PM
MET WITH:	Executive Director, Candi Laird		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not meet the needs of a resident
Staff withheld food and water from a resident
Dangerous items made accessible to resident
Staff did not maintain resident's room

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 deliver findings. The LPA introduced himself and disclosed the purpose of the visit to Executive Director, Candi Laird.

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

It was reported staff did not meet the needs of a resident. A source reported staff did not brush Resident # 1’s (R1) teeth. An interview with R1 revealed R1 was able to brush their own teeth and did not require assistance. Review of R1’s needs and services plan did not corroborate staff were required to brush R1’s teeth. An interview with internal sources revealed it was not common for this service to be provided by the facility.

(See LIC 9099C for continuation of report.)

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (610) 767-2317
LICENSING EVALUATOR NAME: Sabel Martinez	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

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-20220901163543

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: 04/13/2023

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

It was alleged staff withheld food and water from a resident. A source reported the facility withheld food and water from a resident, due to the facility kitchen being closed at night. Interviews with internal sources revealed the kitchen was closed after dinner, but staff had access to the kitchen and would provide snacks, additional food, and water. Throughout visits to the facility, the LPA observed there were multiple water fountains located throughout the building. Additionally, interviews and observations corroborated multiple residents had water and other food items in their rooms. An interview with R1 revealed the resident did not have any concerns with the kitchen being closed, as R1 had food and snacks in R1’s room.

It was alleged dangerous items were made accessible to a resident. A source reported a six to eight-inch knife was witnessed in R1’s bathroom. An interview with R1 revealed these knives were used by R1 to prepare R1’s breakfast. Observations by the LPA corroborated there were multiple knives in R1’s bathroom, and multiple breakfast items in R1’s room, including bread and peanut butter. A review of R1’s physician’s report and needs and services plan did not reveal any concerns with R1 having access to such items.

It was alleged staff did not maintain a resident's room. Interviews with internal sources revealed the staff would clean residents’ rooms once per week, and more frequently if needed. An interview with R1 corroborated staff cleaned their room on a regular basis. The LPA did observe food crumbs throughout R1’s room, and witnessed water and food items in R1’s room. R1 confirmed R1 frequently ate in their room.

Based on the evidence gathered throughout the investigation, there was not a preponderance of evidence to prove the alleged violation occurred, therefore, the allegations are Unsubstantiated.

An exit interview was conducted with Executive Director, Candi laird, to whom a copy of this report, LIC 811 and Licensee/Appeals Rights (LIC 9058) were provided.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (610) 767-2317
LICENSING EVALUATOR NAME: Sabel Martinez	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2