374601046-7-18-2022-18-AS-DMUN-CH6QGC-20220810120919

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374601046
Report Date: 07/18/2022
Date Signed: 07/18/2022 02:22:36 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/26/2022 and conducted by Evaluator Chinwe Nwogene

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20220526161428

FACILITY NAME:	BROOKDALE PLACE OF SAN MARCOS		FACILITY NUMBER:	374601046
ADMINISTRATOR:	PRESTON, MARIO		FACILITY TYPE:	740
ADDRESS:	1590 W SAN MARCOS BLVD		TELEPHONE:	(760) 471-9904
CITY:	SAN MARCOS	STATE: CA	ZIP CODE:	92078
CAPACITY:	245	CENSUS: 168	DATE:	07/18/2022
		UNANNOUNCED	TIME BEGAN:	10:25 AM
MET WITH:	Tania Dupre, Associate Executive Director		TIME COMPLETED:	10:55 AM

ALLEGATION(S):

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Resident sustained pressure injuries while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Chinwe Nwogene made an unannounced visit to the facility to conclude a complaint investigation into the allegation listed above. LPA met with Associate Executive Director, Tania Dupre, and discussed the purpose of the visit. During the investigation, LPA interviewed Resident 1 (R1), Nurse, Executive Director and reviewed resident files.
Regarding the allegation “Resident sustained pressure injuries while in care” during the interview with R1, it was acknowledged that R1 had multiple sores prior to moving into the facility. LPA interviewed R1’s nurse, who confirmed R1 has multiple pressure injuries and is receiving treatment for said injuries. LPA received R1 Physician report which indicated the presence of injuries prior to R1 admission into the facility.
Based on interview with resident, Nurse and file review, there is not enough evidence to corroborate the allegation that Resident sustained pressure injuries while in care. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is unsubstantiated at this time. An exit interview was conducted, and a copy of this report was reviewed with and provided to Tania Dupre.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Chinwe Nwogene	TELEPHONE: (951) 202-2066
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2022

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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