374600735-12-15-2022-08-AS-LTEZ-CMBQS7-20221221112500

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374600735
Report Date: 12/15/2022
Date Signed: 12/15/2022 11:24:06 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
08/15/2022 and conducted by Evaluator Rebecca A Ruiz

COMPLAINT CONTROL NUMBER: 08-AS-20220815081412

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: 83	DATE:	12/15/2022
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Candi Laird		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Licensee did not allow resident access to resident's records

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced complaint investigation visit to deliver findings regarding the above-mentioned allegation. LPA identified herself to, was greeted by, and explained the purpose of the visit to Executive Director Candi Laird.

The Department’s investigation consisted of interviews with residents, staff, and outside sources, records review, and a tour of the facility. It was alleged that the Licensee did not allow resident access to resident’s records. Interviews with the Executive Director (ED) and Business Office Manager (BOM) revealed that the facility’s policy for requesting documents is to submit a written request for copies of documents. The ED and BOM stated that a resident or their responsible party could submit a written request to any staff member and it would be forwarded to the BOM for review and approval. The BOM stated that most resident requests are for billing information and only resident 1 (R1) had requested medical records.

Continued on LIC9099-C page...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Rebecca A Ruiz	TELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022

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 2

Control Number 08-AS-20220815081412

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: 12/15/2022

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 ED and BOM stated that a written request for records would only be denied if the request came from someone other than the resident or their responsible party. Review of the facility’s Authorization to Disclose Protected Health Information effective 9/23/2013 revealed that any requests to inspect or obtain copies of a resident’s protected health information must be made in writing. Any requests to amend any incorrect or incomplete protected health information must also be made in writing. The BOM recalled informing R1 of the facility’s written request policy but that R1 had not submitted a written request as of speaking with LPA Ruiz on November 15, 2022. Interviews and review of progress notes revealed that R1 had been provided with R1’s medical file or offered copies of records upon verbal request.

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

An exit interview was conducted with Executive Director Candi Laird, to whom a copy of this report and the Licensee Appeal Rights (LIC9058 01/16) were provided via hard copy.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Rebecca A Ruiz	TELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 2