191221435-1-18-2024-31-AS-NGID-D26W2A-20240205155401

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191221435
Report Date: 01/18/2024
Date Signed: 01/18/2024 02:11:09 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 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
01/09/2024 and conducted by Evaluator Lorena Casillas

COMPLAINT CONTROL NUMBER: 31-AS-20240109130557

FACILITY NAME:	BROOKDALE CHATSWORTH		FACILITY NUMBER:	191221435
ADMINISTRATOR:	HELEN LEE		FACILITY TYPE:	740
ADDRESS:	20801 DEVONSHIRE BLVD		TELEPHONE:	(818) 341-2552
CITY:	CHATSWORTH	STATE: CA	ZIP CODE:	91311
CAPACITY:	268	CENSUS: 127	DATE:	01/18/2024
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Danny Vera		TIME COMPLETED:	02:25 PM

ALLEGATION(S):

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Staff do not ensure that hot water is available to residents in care.

INVESTIGATION FINDINGS:

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On 01/18/24 at 10:00 am Licensing Program Analyst (LPA), Lorena Casillas conducted an unannounced complaint visit to investigate the above stated allegation. LPA met with Executive Director (ED) Danny Vera and explained the reason for the visit.

At 10:50 AM LPA Casillas conducted a physical plant tour. During the investigation, interviews and record reviews were made. LPA requested resident roster and LIC 500. LPA requested copies of pertinent information relevant to the investigation including but not limited to, maintenance logs, copy of receipts and correspondence to residents.

Continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Lorena Casillas	TELEPHONE: 818-304-2695
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024

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-20240109130557

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: BROOKDALE CHATSWORTH	FACILITY NUMBER: 191221435
	VISIT DATE: 01/18/2024

NARRATIVE

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Allegation#1: Staff do not ensure that hot water is available to residents in care.

LPA interviewed the ED and conducted a physical inspection of random resident rooms. Hot water ranged from temperatures of 117.6, 107.8, 105, 117.8 and 105, which is in compliance with Licensing regulations. Although the ED confirmed the hot water was out, a repair company came the same day that the facility was made aware of the problem and attempted to find the cause. The repair person came out for four (4) days in a row to determine the cause of the problem. It was determined that the piping in one of the rooms was backwards and was throwing off the rooms that were affected. Once the problem was found, the repairs began, and the hot water was reinstated on the fourth day 01/09/2024. In the interim residents were offered other arrangements for accessing hot water. One of the vacant rooms (room 250) had a designated staff member to assist and coordinate showers from 8:00 am to 4:00 pm everyday until the issue was resolved. If the hours needed to be extended the facility was ready to accommodate. The ED sent out a flyer to all residents notifying them that the hot water was not operable but would be fixed as soon as possible. Interviews with eleven out of eleven residents confirmed that the facility notified them regarding the water issue and that it was in the process of being fixed. Interviews with five out of five staff members confirmed that residents were made aware of the situation and were offered an alternative to showering and accessing hot water. Therefore, based on physical plant inspection, and documentation received, the allegation is Unsubstantiated at this time.

Exit interview conducted and a copy of this report was given to ED.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Lorena Casillas	TELEPHONE: 818-304-2695
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024

LIC9099 (FAS) - (06/04)

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