191221435-2-20-2025-31-AS-NGID-DE9P34-20250226095653

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191221435
Report Date: 02/20/2025
Date Signed: 02/20/2025 02:34:41 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/10/2025 and conducted by Evaluator Angela Panushkina

COMPLAINT CONTROL NUMBER: 31-AS-20250210124020

FACILITY NAME:	BROOKDALE CHATSWORTH		FACILITY NUMBER:	191221435
ADMINISTRATOR:	AMANDA MONROY		FACILITY TYPE:	740
ADDRESS:	20801 DEVONSHIRE BLVD		TELEPHONE:	(818) 341-2552
CITY:	CHATSWORTH	STATE: CA	ZIP CODE:	91311
CAPACITY:	268	CENSUS: 120	DATE:	02/20/2025
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Anchirriza Concepcion, Health and Wellness Director		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Staff does not ensure resident's bathing needs are being met.
Staff leaves resident soiled for extended periods of time.

INVESTIGATION FINDINGS:

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At 09:50am, Licensing Program Analyst (LPA), Angela Panushkina, arrived at Brookdale Chatsworth in response to the above-mentioned allegations. LPA met with the Health and Wellness Director and Business Office Manager and explained the reason for the visit.

At 09:55am, LPA requested resident and staff roster. At 10:00am requested copies of pertinent information which include, but not limited to Physician’s report, Admission Agreement, Appraisal Needs and Services Plan, Staff Training, Shower Log, relevant to the investigation. At approximately 10:10am, LPA conducted a physical plant tour, to ensure health and safety of the residents are protected. Between 10:20am - 02:30pm, LPA interviewed the Business Office Manager (BOM), Health and Wellness Director (HWD), four (4) staff and eleven (11) out of twelve (12) residents. Also, while interviewing a sample of twelve (12) residents, LPA randomly tested three (3) resident pendants.

Continue on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025

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 31-AS-20250210124020

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: BROOKDALE CHATSWORTH	FACILITY NUMBER: 191221435
	VISIT DATE: 02/20/2025

NARRATIVE

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Allegation: Staff does not ensure resident's bathing needs are being met.

It was alleged that the facility do not care for R1's hygiene/shower in a timely manner. To investigate this allegation while interviewing a sample of twelve (12) residents, LPA conducted a random inspection of three (3) pendants and staff responded within a reasonable time. Interview with the Business Office Manager (BOM) and Health and Wellness Director (HWD) revealed that the facility’s expectation for response time is 15 minutes. In addition, BOM and HWD informed LPA that all residents are provided showers at least twice a week or as needed. LPA conducted interviews with four (4) staff members, and all parties interviewed confirmed the statements provided by BOM and HWD. Interviews with four (4) staff also revealed that they respond to residents' call buttons immediately and if the staff member is not available to assist, they communicate with each other to make sure the call/page is taking care of right away by the next available staff. Interviews with eleven (11) out of twelve (12) residents expressed no concerns regarding the above allegation. Based on interviews and the information received, allegation is deemed Unsubstantiated at this time.

Allegation: Staff leaves resident soiled for extended periods of time.

It was alleged that R1 was left in his/her own feces and not being cleaned. To investigate this allegation LPA conducted an interview with the Business Office Manager (BOM), Health and Wellness Director (HWD) and was informed that all incontinent residents are scheduled to be changed every two hours or as needed. Furthermore, interview with four (4) staff members confirmed the statement provided by the BOM and HWD. LPA was also informed that R1 was able to independently care for self. LPA conducted an interview with R1 and was informed that he/she is independent and requires no assistance from the staff. Lastly, eleven (11) out of twelve (12) residents interviewed, expressed no concerns regarding this allegation. Based on the information obtained through interviews, there was insufficient evidence to prove R1 was left in soiled for an extended period of time. Therefore, the allegation is deemed Unsubstantiated at this time.

No deficiency issued during todays visit.

Exit interview conducted and copy of this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025

LIC9099 (FAS) - (06/04)

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