374600735-6-23-2023-08-AS-LTEZ-CT9W2N-20230629165436

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374600735
Report Date: 06/23/2023
Date Signed: 06/23/2023 11:36:12 AM

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
01/10/2022 and conducted by Evaluator Rebecca A Ruiz

COMPLAINT CONTROL NUMBER: 08-AS-20220110140458

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: 79	DATE:	06/23/2023
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Business Office Manager Samantha Elizondo		TIME COMPLETED:	11:35 AM

ALLEGATION(S):

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Staff did not provide proper food service to resident in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced complaint visit to conduct follow-up and deliver findings regarding the above-mentioned allegation. LPA identified herself to, was greeted by, and explained the purpose of the visit to Business Office Manager Samantha Elizondo.

During today’s visit, LPA observed residents in care and interviewed staff.

The Department’s investigation consisted of interviews with staff, residents, and outside sources, records review, and a tour of the facility. It was alleged that staff did not provide proper food service to resident in care. Interviews revealed that residents were given the option to eat their meals in the dining room, take pre-prepared meal trays to their room, or have meals trays delivered to their room. Interviews and review of the facility’s admission agreement revealed that facility staff provided tray services to residents at no additional cost for any temporary illness or injury.
Continued on LIC9099-C page...

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Rebecca A Ruiz	TELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2023

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-20220110140458

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: 06/23/2023

NARRATIVE

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The facility provided optional tray service at an additional fee outlined in the admission agreement. Interviews revealed that dining staff would receive orders from caregivers and would prepare the tray with the requested food items and would deliver food trays to the residents’ rooms. Interviews revealed that there were between 4-10 residents who regularly requested tray service for a meal and dining staff would take approximately 45 minutes to deliver all the meals to resident rooms.

Interviews revealed that since 2020, the facility’s dining room had been closed multiple times due to facility renovations and COVID-19 guidance. Interviews revealed that during those facility closures, staff would deliver food trays to all residents at no additional charge and staff would take approximately one to two hours to deliver meals trays to all residents in care. Interviews revealed that staff would take a portion of the meal trays at a time to ensure the food would not get cold while staff delivered trays. Interviews revealed that if the dining staff were short staffed, caregivers would assist with delivering trays but did not assist in preparation. Interviews did not reveal any instances of residents not receiving meal trays during dining room closures.

The Department has investigated the above-mentioned allegation and based on interviews, the preponderance of the evidence has not been met, therefore, this allegation is deemed unsubstantiated.

An exit interview was conducted with Business Office Manager Samantha Elizondo, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 01/16).

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Rebecca A Ruiz	TELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2023

LIC9099 (FAS) - (06/04)

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