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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361881034
Report Date: 04/28/2025
Date Signed: 04/28/2025 02:48:41 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO 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
09/20/2022 and conducted by Evaluator Sarina Ramirez
COMPLAINT CONTROL NUMBER: 56-AS-20220920133432
FACILITY NAME:BROOKDALE LOMA LINDAFACILITY NUMBER:
361881034
ADMINISTRATOR:LUJAN, MARITZAFACILITY TYPE:
740
ADDRESS:25585 VAN LEUVEN STREETTELEPHONE:
(909) 796-5421
CITY:LOMA LINDASTATE: CAZIP CODE:
92354
CAPACITY:220CENSUS: 111DATE:
04/28/2025
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Executive Director Maritza LujanTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident sustained bruise from staff while in care
Staff is not responding to resident call pendants in a timely manner
Staff is not treating resident with dignity and respect
Staff did not change resident's diaper in a timely manner
INVESTIGATION FINDINGS:
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13
Licensing Program Analyst (LPA) Sarina Ramirez conducted an unannounced visit to the facility to deliver findings on a complaint investigation regarding the above allegations. LPA met with Executive Director Maritza Lujan and discussed the purpose of the visit.

Regarding Allegation #1, it was alleged Resident 1 (R1) sustained a bruise from staff while in care. R1 moved out of the facility in November 2024 and was unavailable to be interviewed. LPA interviewed 11 residents, which all informed LPA they have not sustained bruising from staff. LPA interviewed 5 staff, which all have informed LPA they have not left brusies on residents, nor have they seen or heard of other staff leave bruises on residents.

Regarding Allegation #2, LPA interviewed 11 residents, 4 out of 11 residents informed LPA staff respond to call pendant in a timely manner. 1 out of 11 residents informed LPA staff do not respond to call pendant in a timely manner. 4 out of 11 residents informed LPA they are independent and never had to use their call pendants. 1 out of 11 residents informed LPA staff sometimes respond to call pendant in a timely manner.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Sarina Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2025
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 2
Control Number 56-AS-20220920133432
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: BROOKDALE LOMA LINDA
FACILITY NUMBER: 361881034
VISIT DATE: 04/28/2025
NARRATIVE
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1 out of 11 residents was nonverbal and unable to answer whether staff respond in a timely manner to call pendant. As LPA interviewed a resident in their room, their call pendant was pushed and tested. LPA observed staff respond to the call pendant in 5 minutes and 30 seconds proving staff attend to call pendant in a timely manner. LPA interviewed 5 staff, which all have stated they respond to call pendants in a timely manner, they all try to respond to calls within 10 minutes max.

Regarding Allegation #3, staff interviewed 11 residents. 10 out of 11 residents informed LPA staff treat them with dignity and respect. 1 out of 11 residents informed LPA some staff but not all treat them with dignity and respect. LPA interviewed 5 staff, which all have stated they treat residents with dignity and respect.

Regarding Allegation #4, LPA interviewed 11 residents. 6 out of 11 residents informed LPA they do not use diapers. 2 out of 11 residents informed LPA they change their own diapers. 1 out of 11 residents informed LPA staff change their diaper in a timely manner. 1 out of 11 residents informed LPA staff do not change their diaper in a timely manner. 1 out of 11 residents was nonverbal and unable to answer whether or not they used diapers or if staff change in a timely manner.

Based on observation, interviews, and pertinent documents the allegations are unsubstantiated. An Unsubstantiated complaint means, that 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.

An exit interview was conducted with Executive Director Maritza Lujan and a copy of this report was provided at the conclusion of the visit.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Sarina Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2