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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374601046
Report Date: 07/27/2023
Date Signed: 07/27/2023 12:12:26 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 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
07/18/2023 and conducted by Evaluator Chinwe Nwogene
COMPLAINT CONTROL NUMBER: 18-AS-20230718143308
FACILITY NAME:BROOKDALE PLACE OF SAN MARCOSFACILITY NUMBER:
374601046
ADMINISTRATOR:PRESTON, MARIOFACILITY TYPE:
740
ADDRESS:1590 W SAN MARCOS BLVDTELEPHONE:
(760) 471-9904
CITY:SAN MARCOSSTATE: CAZIP CODE:
92078
CAPACITY:245CENSUS: 152DATE:
07/27/2023
UNANNOUNCEDTIME BEGAN:
09:38 AM
MET WITH:Mario Preston, Executive DirectorTIME COMPLETED:
12:15 PM
ALLEGATION(S):
1
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9
Staff are not abiding by the addendum to the admissions agreement.
INVESTIGATION FINDINGS:
1
2
3
4
5
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7
8
9
10
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13
On 7/27/2023, Licensing Program Analyst (LPA) Chinwe Nwogene conducted an unannounced visit to investigate the above allegation. LPA met with Executive Director, Mario Preston who was informed of the purpose of the visit. At the time of visit, LPA interviewed staff and reviewed resident records.
Regarding the allegation “Staff are not abiding by the addendum to the admissions agreement”, it was alleged facility is not abiding by the rental amount on the addendum to the admissions agreement. LPA interviewed Executive Director (ED) who stated resident’s rental amount when resident moved in was $3930. ED stated resident’s responsible party (RP) was notified in October 2022 about $4473 rent increase effective January 1, 2023. ED stated resident’s RP requested for a rent reduction and a retention discount of $113 was granted. ED stated an addendum was signed in December 2022 to document the discount. ED stated the addendum, which was signed in December 2022, shows the $3930 old rental amount because the $4473 new rental amount for 2023, has not taken effect and cannot be changed in their system. ED stated resident’s RP was informed during the signing that the new rental amount will supersede the amount on the addendum effective January 1, 2023. LPA reviewed the residents record and observed the addendum which was signed in December 2022 documented the $113 retention discount. Resident account history report was reviewed and revealed the new rental amount $4473 took effect January 1, 2023, and the $113 retention discount was applied accordingly.
Based on LPA’s interviews with staff and resident’s record review, there is not enough evidence to support the above allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation are unsubstantiated at this time. An exit interview was conducted, and a copy of this report was reviewed with and provided to Mario Preston.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Chinwe NwogeneTELEPHONE: (951) 202-2066
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023
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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