191221839-6-29-2021-28-AS-LHIS-C76S2A-20210924132911

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191221839
Report Date: 06/29/2021
Date Signed: 06/29/2021 12:32:50 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/22/2021 and conducted by Evaluator Cynthia D Chan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20210622162841

FACILITY NAME:	BROADVIEW RESIDENTIAL CARE CENTER		FACILITY NUMBER:	191221839
ADMINISTRATOR:	BETSY K DAVIS		FACILITY TYPE:	740
ADDRESS:	535 WEST BROADWAY		TELEPHONE:	(818) 246-4951
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91204
CAPACITY:	180	CENSUS: 63	DATE:	06/29/2021
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Betsy Davis, Administrator		TIME COMPLETED:	12:35 PM

ALLEGATION(S):

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Facility staff did not meet resident's hygiene needs.
Facility staff did not clean resident's room.
Resident was charged for services not received.
Facility staff did not follow resident's doctor's orders.
Resident was left in bed all day resulting in pressure injuries.
Facility was in disrepair/broken equipment.
Facility did not provide a safe environment for resident.
Facility had pests.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Cynthia Chan and Nina Galarza conducted a complaint investigation for the allegations listed above. LPAs met with Betsy Davis, the Administrator and explained the purpose of the visit.

During today’s visit, LPAs Chan and Galarza interviewed the Administrator, one Staff, and obtained a copy of the staff and resident roster. LPAs also interviewed the Administrator and the Medical Record Personnel from the Broadway Manor (skilled nursing home) at 605 W. Broadway Glendale 91204.
Based on interview and document reviewed, Resident #1 (R1) did not reside at this facility but at the Broadway Manor.
We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without reasonable basis. We have therefore dismissed the complaint.
An exit interview was conducted with the Administrator. This report was sent via email for a signature and appeal rights were also provided.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2021

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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