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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374600735
Report Date: 08/19/2022
Date Signed: 08/19/2022 01:19:07 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
04/05/2022 and conducted by Evaluator Sabel Martinez
COMPLAINT CONTROL NUMBER: 08-AS-20220405110045
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: 93DATE:
08/19/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Business Office Manager, Nicole NobleTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff did not keep resident’s room free from odor.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Sabel Martinez, conducted an unannounced complaint visit to deliver findings regarding the above-mentioned allegation. The LPA was greeted by Business Office Manager, Nicole Noble, identified himself, and disclosed the purpose of the visit.

The Department’s investigation consisted of observations, review of records, and interviews with internal and external sources.

It was alleged staff did not keep resident’s room free from odor. Interviews with internal and external sources revealed the facility did not have an adequate amount of housekeeping staff to clean the residents’ rooms. During the time period in question, the facility employed one housekeeping staff to clean all residents’ rooms (106), and provide laundry services. On multiple occasions not all scheduled rooms were cleaned, and multiple residents reported dissatisfaction to management.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (610) 767-2317
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2022
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 5
Control Number 08-AS-20220405110045
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: 08/19/2022
NARRATIVE
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No additional staff was tasked with assisting in deep cleaning resident rooms, but instead additional staff would organize and remove any immediate trash witnessed to be in the rooms. Observations revealed clutter in residents rooms, multiple rooms with smells of urine emanating into the hallways, empty and half full male urinals in rooms, and multiple rooms with cockroaches and pest spray. Documents obtained at the facility corroborated the access for a professional pest control services was limited due to “many rooms” having clutter, stored items and lack of room preparation for professional services to be provided, Therefore, “making effective service nearly impossible.”

Based on the evidence gathered from observations, interviews with internal and external sources, the preponderance of evidence standard was met to Substantiate the above allegation. Per California Code of Regulations, Title 22, this deficiency was cited in an LIC 809D. A Plan of Correction was jointly developed with Business Office Manager, Nicole Noble.

An exit interview was conducted with Business Office Manager, Nicole Noble, to whom a copy of this report, LIC 809D and Licensee's Rights (LIC 9058 01/16) were provided to.

SUPERVISOR'S NAME: Denise PowellTELEPHONE: (610) 767-2317
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 08-AS-20220405110045
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: 08/19/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/19/2022
Section Cited
CCR
87303(a)
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87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidence by:
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Lincesee has hired additional housekeeping staff to include a total of 3 housekeepers, 1 dedicated staff to provide laundry services, 1 maintnance tech, and 1 maintnance manager. A room cleaning schedule was provided to the LPA. The plan of correction was cleared on today's date 8/19/2022.
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Based on observation, review of records, and interviews, the licensee did not ensure resident rooms were clean and sanitary, which posed a potential health, safety, and personal rights risk to 93 of 93 residents in care.
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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: 08/19/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
04/05/2022 and conducted by Evaluator Sabel Martinez
COMPLAINT CONTROL NUMBER: 08-AS-20220405110045

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: 93DATE:
08/19/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Business Office Manager, Nicole Noble TIME COMPLETED:
01:30 PM
ALLEGATION(S):
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9
Staff did not keep kitchen free from pests.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Sabel Martinez, conducted an unannounced complaint visit to deliver findings regarding the above-mentioned allegation. The LPA was greeted by Business Office Manager, Nicole Noble, identified himself, and disclosed the purpose of the visit.

The Department’s investigation consisted of observations, review of records, and interviews with internal and external sources.

It was alleged staff did not keep kitchen free from pests. Professional pest control service documents obtained at the facility did not indicate any need for services in the kitchen, nor pests being witnessed to be present in the kitchen. Interviews with internal and external sources did not corroborate pest being present in the kitchen area of the facility. Additionallly, observations revealed the kitchen to be clean and did not corroborate any concerns with pest being present.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (610) 767-2317
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 08-AS-20220405110045
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: 08/19/2022
NARRATIVE
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Based on the evidence gathered throughout the investigation, there is not a preponderance of evidence to prove the alleged violation occurred, therefore, the allegation is unsubstantiated.

An exit interview was conducted with Business Office Manager, Nicole Noble, to whom a copy of this report, and Licensee's Rights (LIC 9058 01/16) were provided to.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (610) 767-2317
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5