191221435-8-13-2025-31-AS-NGID-DLKU9L-20250916152318

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191221435
Report Date: 08/13/2025
Date Signed: 08/13/2025 01:09:01 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
09/13/2024 and conducted by Evaluator Angela Panushkina

COMPLAINT CONTROL NUMBER: 31-AS-20240913143615

FACILITY NAME:	BROOKDALE CHATSWORTH		FACILITY NUMBER:	191221435
ADMINISTRATOR:	DANNY VERA		FACILITY TYPE:	740
ADDRESS:	20801 DEVONSHIRE BLVD		TELEPHONE:	(818) 341-2552
CITY:	CHATSWORTH	STATE: CA	ZIP CODE:	91311
CAPACITY:	0	CENSUS: 127	DATE:	08/13/2025
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	David Monroy, Executive Director		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff is not feeding an adequate amount of food to residents in care.
Facility is not following posted menu.

INVESTIGATION FINDINGS:

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

At 09:30am, Licensing Program Analysts (LPAs), Angela Panushkina and Huma Rahimi, conducted a subsequent visit to deliver final report. LPAs met with the Executive Director and explained the reason for the visit.

During the initial visit, conducted on 09/18/24, LPA requested resident and staff roster. At 09:45am requested copies of pertinent information which include, but not limited to Physician’s report, Admission Agreement, Appraisal Needs and Services Plan, Menu, relevant to the investigation. At approximately 09:50am, LPA conducted a physical plant tour, to ensure health and safety of the residents are protected. Between 10:00am - 02:30pm, LPA interviewed the Executive Director, Health and Wellness Director (LVN), MedTech, two (2) staff and twelve (12) out of thirteen (13) residents.

Continue on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025

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 31-AS-20240913143615

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: 08/13/2025

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

Allegation: Staff is not feeding an adequate amount of food to residents in care.

It was alleged that residents are only served a bagel with cream cheese and jelly for breakfast. To investigate this allegation, at approximately 10:00am, LPA made a visit to the kitchen and observed it is fully stocked with perishable and non-perishable foods. LPA also observed the residents with special dietary needs are posted in the kitchen prep area with pictures of the residents and their food choices or required preparation. Interview with the Chef and a cook revealed that the food is restocked regularly at least 2 times a week, on Monday and Thursday. The document review of food options revealed facility provides variety of food that include protein, grains or starch, vegetables, dairy, and fruits or juice daily. LPA observed the lunch ingredients being prepared for the day as followed: steak and potato soup, carnitas, grilled shrimp, mixed green salad and creamy mushroom pork chops. Additionally, LPA was informed that an alternative menu for breakfast, lunch and dinner is also available (daily). Review of the facility menu (for 09/18/24) confirmed the accuracy of providing meals for that day. Interviews with the Chef, cooks and the Administrator also revealed that the residents never had any concerns and that the staff will also customize food being served upon resident's request. Twelve (12) out of thirteen (13) residents interviewed expressed no concerns regarding this allegation and informed LPA that the facility always provides adequate food for breakfast, lunch and dinner. Based on LPA's interviews, observation, and document review the above allegation is found Unsubstantiated, at this time.

Allegation: Facility is not following posted menu.

To investigate this allegation, LPA conducted a tour in the kitchen, and interviewed staff and residents. Interviews with twelve (12) out of thirteen (13) residents revealed that the facility always follows the daily menu. All residents interviewed expressed no concerns regarding this allegation. Moreover, interview with the Chef and a cook revealed that very rarely, due to the shortage of ingredients and or staff (since some meal preparations can be time consuming), the facility may change the menu. However, once that happens, all residents are made aware of the changes, promptly. Lastly, at 11:30am, while interviewing residents in the dining area, LPA observed lunch being served is consistent with the daily menu. Based on information obtained through interviews and document review this allegation is deemed Unsubstantiated, at this time.

No citations issued during today's 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: 08/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 2