336426434-3-8-2023-18-AS-EMAN-CPVSET-20230313134914

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426434
Report Date: 03/08/2023
Date Signed: 03/08/2023 09:46:31 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
12/01/2020 and conducted by Evaluator Ryan Gardner

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20201201121324

FACILITY NAME:	BROOKDALE CORONA		FACILITY NUMBER:	336426434
ADMINISTRATOR:	MARITZA LUJAN		FACILITY TYPE:	740
ADDRESS:	2005 KELLOGG AVE		TELEPHONE:	(951) 898-6991
CITY:	CORONA	STATE: CA	ZIP CODE:	92879
CAPACITY:	60	CENSUS: 42	DATE:	03/08/2023
		UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Jennifer Sanchez "Lazaro" - Business Office Coordinator		TIME COMPLETED:	09:55 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff abandoned resident.

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Ryan Gardner conducted an unannounced visit to the facility to conclude and deliver findings for the above complaint allegation that was initiated on 12/7/2020. LPA met with Business Office Coordinator Jennifer Sanchez "Lazaro" and explained the reason for the visit.

During today’s visit, LPA interviewed staff and requested and reviewed facility documents.

For allegation, Facility staff abandoned resident:

It was alleged that the facility did not allow Resident R1 to return to the facility due to a medical diagnosis.
During interview conducted with staff, LPA was informed that the staff that sent R1 to the hospital does not work at the facility as of 8/7/2022. R1 moved out of the facility on 8/7/2021 and their whereabouts are unknown.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Ryan Gardner
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2023

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 18-AS-20201201121324

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: BROOKDALE CORONA	FACILITY NUMBER: 336426434
	VISIT DATE: 03/08/2023

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

During document review, LPA discovered R1 was sent to the hospital on 11/30/2020 due to a medical concern. R1 returned to the facility the morning of 12/1/2020. On the evening of 12/1/2020, R1 was sent back to the hospital due to further medical concerns. On the morning of 12/4/2020, R1 returned to the facility. R1 was accepted back to the facility with a medical diagnosis. LPA did not discover evidence to collaborate that R1 was abandoned by the facility.

Based on the evidence found during the investigation, the allegation listed above is deemed UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means 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.

During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report was discussed and provided to Business Office Coordinator Jennifer Sanchez "Lazaro", along with a copy of the appeal rights.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Ryan Gardner
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2