374601046-8-4-2023-18-AS-JDHS-CW8TUN-20231002150237

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374601046
Report Date: 08/04/2023
Date Signed: 08/04/2023 01:01:28 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
07/28/2023 and conducted by Evaluator Chinwe Nwogene

COMPLAINT CONTROL NUMBER: 18-AS-20230728084050

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: 159	DATE:	08/04/2023
		UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Amber Rodgers, Associate Executive Director		TIME COMPLETED:	01:05 PM

ALLEGATION(S):

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Staff did not ensure that resident has their medications.
Staff mismanaged resident's medications.

INVESTIGATION FINDINGS:

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On 08/04/2023, Licensing Program Analyst (LPA) Chinwe Nwogene conducted an unannounced visit to investigate the above allegations. LPA met with Associate Executive Director, Amber Rodgers who was informed of the purpose of the visit. During the investigation, Staff and resident were interviewed, resident’s file was reviewed.
Regarding the allegation “Staff did not ensure that resident has their medications”, it was alleged staff did not administer PM medication to resident. Staff was interviewed who denied staff did not administer PM medication to resident. Staff stated resident administers own medications but suddenly requested that facility help administer residents’ medications. Staff stated facility only administered the medication for three #3 days before resident’s responsible party requested all medications be returned to resident. Resident was interviewed, who denied received any PM medication but acknowledged all medications has been returned to resident. Resident’s file review revealed resident stored and administered own medications. Medication Administration Record (MAR) review revealed staff administered AM and PM medications to resident on 7/25/2023, and 7/26/2023. On 7/27/2023 only AM medication was administered before medication was returned to resident to begin unsupervised self-administration.

Continue on LIC9099C

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Chinwe Nwogene	TELEPHONE: (951) 202-2066
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023

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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Control Number 18-AS-20230728084050

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: BROOKDALE PLACE OF SAN MARCOS	FACILITY NUMBER: 374601046
	VISIT DATE: 08/04/2023

NARRATIVE

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Continued from LIC9099.

Regarding the allegation “Staff mismanaged resident's medications”, LPA interviewed staff who denied mismanaged resident's medications. Staff stated resident administers own medication but suddenly requested that facility help administer residents’ medications. Staff stated facility only administered the medication for three #3 days before resident’s responsible party requested all medications be returned to resident. Resident’s interview revealed resident stores and self-administers own medications. Resident’s file review revealed resident stores and administered own medications.

Based on interviews with staff and resident and resident’s file review, there is not enough evidence to support the above allegations. 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 allegations are unsubstantiated at this time. An exit interview was conducted, and a copy of this report was reviewed with and provided to Amber Rodgers.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Chinwe Nwogene	TELEPHONE: (951) 202-2066
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023

LIC9099 (FAS) - (06/04)

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