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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374601046
Report Date: 10/09/2025
Date Signed: 10/09/2025 03:09:04 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
10/13/2022 and conducted by Evaluator Deborah Lee
COMPLAINT CONTROL NUMBER: 18-AS-20221013102800
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: 173DATE:
10/09/2025
UNANNOUNCEDTIME BEGAN:
08:47 AM
MET WITH:Amber RogersTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Facility failed to assist resident with oral hygiene
Facility failed to seek dental treatment for resident
INVESTIGATION FINDINGS:
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On October 9, 2025, the Department of Social Services staff conducted an unannounced visit to this facility to continue investigation of the above allegations and to deliver findings. The Department was met by Amber Rogers; Executive Director, and the purpose of the visit was explained.
Investigation consisted of the following:
On 10/17/22, the Department conducted an unannounced initial visit to the facility to investigate the allegations mentioned above. During the visit, the Department reviewed files and collected pertinent documents. Additionally, an interview with Associate Executive Director was conducted. It was determined that the complaint required further investigation.
On 10/9/25 the Department, interviewed Amber Rogers, Executive Director (A1), 3 staff (S1-S3), 3 residents (R2-R4). The Department obtained and reviewed the following documents: Staff roster (dated:10/9/25) resident roster (dated: 10/9/25), R1 Physicians report (dated: 4/11/24), R1 pre-placement appraisal (date: 9/20/21), R1’s Personal Services Plan (dated: 8/25/22, 2/25/22), Progress notes (dated: 10/2022)., dental presciption (dated 10/25/25).
Page 1 of 4
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025
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 4
Control Number 18-AS-20221013102800
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: 10/09/2025
NARRATIVE
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The investigation revealed the following:

Allegation: Facility failed to assist resident with oral hygiene

The detail of the complaint alleges that R1 doesn’t consistently practice oral hygiene, and staff are not assisting her.

On 10/9/25 at 10:36am, the Department interviewed the Executive Director (A1) who stated that she was not working at the facility in 2022, however A1 informed the Department that any orders from medical professionals are followed. A1 further stated, “if residents receive a signed order for dental hygiene assistance, the order would be put on the care plan, and it would be followed by our care partners.” A care partner is assigned to the resident who needs assistance and the order is carried out as required.

On 10/9/25, between 10:30 and 12:30pm, the Department interviewed 3 staff (S1-S3) regarding the allegation, and of those interviewed 2 out of 3 were working at the facility in 2022 during the time of the allegation. 2 out of 3 stated that R1 was given help with her oral hygiene when they were allowed to do so; they further explained that at times resistance came from R1’s husband who limited any contact from caregivers to assist R1, so they did what they could.

On 10/9/25, between 1:30 and 3:30pm, the Department interviewed 3 residents (R2-R4). R1 could not be interviewed as she passed away on 2024. Of those interviewed 3 out of 3 stated that they don’t have dental issues but if they needed help, the staff would help them. 3 out of 3 stated that they make their own dental appointments.

On 10/9/25, the Department obtained, reviewed, and evaluated the following documents: R1 Physicians report (dated: 4/11/24), R1 pre-placement appraisal (date: 9/20/21), R1’s Personal Services Plan (dated: 8/25/22, 2/25/22), Progress notes (dated: 10/2022), Prescription from dentist (dated: 10/25/22. There were no other dental information available for review.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 18-AS-20221013102800
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: 10/09/2025
NARRATIVE
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Based on the interviews and information gathered, there is insufficient evidence to support the allegation mentioned above; 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 is UNSUBSTANTIATED

Allegation: Facility failed to seek dental treatment for resident.

The detail of the complaint alleges that R1 has severe dental hygiene challenges and facility has not followed through with oral care needed for R1 to have healthy teeth and gums.

On 10/9/25 at 10:36am, the Department interviewed the Executive Director (A1) who stated that she was not working at the facility in 2022, however A1 informed the Department that any orders from medical professionals are followed. A1 also stated that “Most of the time, the family will handle dental appointments for the residents. Lastly, A1 stated, “if residents receives a signed order for dental hygiene assistance, they would be put on the care plan, and it is followed by our care partners.” They are assigned to a specific care partner who would help them.

On 10/9/25, between 10:30 and 12:30pm, the Department interviewed 3 staff (S1-S3) regarding the allegation, as mentioned above, of those interviewed 2 out of 3 were working at the facility in 2022 during the time of the allegation. 2 out of 3 stated that R1 was given help with her oral hygiene when they were allowed to do so; they further explained that at times resistance came from R1’s husband who limited any contact from caregivers to assist R1, so they did what they could.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 18-AS-20221013102800
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: 10/09/2025
NARRATIVE
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On 10/9/25, the Department obtained, reviewed, and evaluated the following documents: R1 Physicians report (dated: 4/11/24), R1 pre-placement appraisal (date: 9/20/21), R1’s Personal Services Plan (dated: 8/25/22, 2/25/22), Progress notes (dated: 10/2022) and R1's dental prescription (dated 10/25/25). There were no other dental documents available for review.

Based on the interviews and information gathered, there is insufficient evidence to support the allegation mentioned above; 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 is UNSUBSTANTIATED

There were no deficiencies cited during today’s visit.

An exit interview conducted with Executive Director, Amber Rogers, and copy of report provided.

Page 4 of 4

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4