374600735-12-30-2025-08-AS-BFOG-DQ5QZE-20260108113636

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374600735
Report Date: 12/29/2025
Date Signed: 12/30/2025 08:13:32 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 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
05/24/2022 and conducted by Evaluator Daisy Panlilio

COMPLAINT CONTROL NUMBER: 08-AS-20220524140351

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:	0	CENSUS: 89	DATE:	12/29/2025
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Ernest Lewis, Executive Director (ED)		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Facility is in disrepair
Licensee did not meet resident’s needs
Staff are not following COVID-19 masking requirements

INVESTIGATION FINDINGS:

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On 12/2925 at 1PM, Licensing Program Analyst (LPA) D Panlilio conducted a subsequent complaint visit, met with staff (ED) and explained the purpose of the visit. LPA delivered investigation finding to ED.

During investigation, LPA S Martinez made observations and conducted interviews with reporting party (RP), residents (R1, R2, R3) and staff (Former ED, Business Office Manager (BOM), Maintenance Director (MD) on 08/09/22, 08/11/22, 09/22/22 and 09/26/22. Review of RCFE Brookdale Clairemont facility # 374600735 history showed that it was closed on 09/30/23 and a change of ownership was effective 10/01/23 under new facility RCFE Novellus Clairemont LLC facility# 34605722. On 10/15/25, LPA D Panlilio spoke with executive director (ED) and requested additional information on the allegations. On 10/24/25, ED stated he was unable to locate the previous records from closed facility Brookdale Clairemont after searching the storage areas, record keeping locations for previous ED or residents’ records.

Continued on next page, LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:	DATE: 12/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2025

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-20220524140351

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: BROOKDALE CLAIREMONT	FACILITY NUMBER: 374600735
	VISIT DATE: 12/29/2025

NARRATIVE

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Allegation: Facility is in disrepair
Finding: Unsubstantiated
During investigation, LPA S Martinez interviewed staff (Former ED, BOM, MD) and residents (R1, R2, R3) who stated that the facility did not have an adequate amount of housekeeping staff to clean the residents’ rooms. Observations revealed clutter/trash in residents’ rooms, multiple rooms with smells of urine emanating into the hallways, room empty with half full male urinals in rooms. Maintenance Director (MD) confirmed with LPA S Martinez that the facility only had one housekeeper assigned to clean over 100 rooms per week. MD also stated that multiple residents have expressed concerns about their rooms not being cleaned. On 10/15/25, LPA D Panlilio requested copies of written documentation regarding facility’s maintenance records from ED. Due to facility closure on 09/30/23, ED stated archived documents were no longer available for this facility. LPA was also unable to contact former staff and residents to obtain additional information on the allegation. Although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation that facility is in disrepair was found to be unsubstantiated.

Allegation: Licensee did not meet resident’s needs

Finding: Unsubstantiated
During investigation, LPA S Martinez interviewed reporting party (RP), residents (R1, R2), Long Term Care Ombudsman (LTCO) and staff (ED). RP stated that the facility staff are changing R1’s colostomy bag every 10 days instead of the agreed 4 days. On 10/15/25, LPA D Panlilio requested copies of written documentation regarding R1’s signed admission agreement, Needs & Services plan, level of care notes and incident reports from ED. Due to facility closure on 09/30/23, ED stated archived documents were no longer available for this facility. LPA was also unable to contact former staff and residents to obtain additional information on the allegation. Although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation that licensee did not meet resident’s needs was found to be unsubstantiated.

Continued on next page, LIC9099-C pg2

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:	DATE: 12/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 08-AS-20220524140351

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: BROOKDALE CLAIREMONT	FACILITY NUMBER: 374600735
	VISIT DATE: 12/29/2025

NARRATIVE

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Allegation: Staff are not following COVID-19 masking requirements
Finding: Unsubstantiated
During investigation, LPA D Correla interviewed reporting party (RP), resident (R1) and staff (Former ED) on 06/02/22. RP stated when she visited R1 at the facility, she observed two staff (receptionist and another staff unknown) not wearing face masks. Review of facility history showed that on 07/28/22 and 08/01/22, LPA M Garcia- Centeno spoke with Resident Care Coordinator and discussed facility’s COVID-19 mitigation plan, followed-up with Public Health for surveillance release and updated COVID-19 database. On 10/15/25, LPA D Panlilio requested copies of written documentation regarding COIVD-19 incident reports from ED. Due to facility closure on 09/30/23, ED stated archived documents were no longer available. LPA was also unable to contact former staff and residents to obtain additional information on the allegation. Although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation that licensee did not post a copy of the approved admission agreement was found to be unsubstantiated.

No deficiency cited during investigation.

Exit interview conducted and a copy of this report provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:	DATE: 12/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2025

LIC9099 (FAS) - (06/04)

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