191221839-8-15-2023-31-AS-RORN-D5GQ3W-20240521114925

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191221839
Report Date: 08/15/2023
Date Signed: 08/15/2023 02:16:23 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.ASC, 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
08/11/2023 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20230811092041

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: 70	DATE:	08/15/2023
		UNANNOUNCED	TIME BEGAN:	09:06 AM
MET WITH:	Betsy Davis - Administrator		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Staff are not allowing residents to participate in activities

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced initial complaint visit at this facility to investigate the above allegation. LPA met with Administrator Betsy Davis and explained the reason for this visit.

LPA conducted physical plant tour at 9:48 AM, requested copy of facility documents relevant to the investigation at 10:10 AM and interviewed residents and staff between 10:15 AM to 1:00 PM. It was alleged that the Administrator took a card game away from Resident #1 (R1) because there must be 10 players to play. LPA's interview with the administrator today at 10:15 AM revealed that she did not take away any card game from any resident but only changed the card game activity to another form of activity so more residents could participate. LPA's observation during physical plant tour at 10:00 AM revealed that the card game that was supposed to be taken by the administrator was at R1's room as it has always been per LPA's interview with the Activity Director at around 10:43 AM. (continued on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

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-20230811092041

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: BROADVIEW RESIDENTIAL CARE CENTER	FACILITY NUMBER: 191221839
	VISIT DATE: 08/15/2023

NARRATIVE

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(continued from LIC 9099)

Further interview with the Activity Director also revealed that while it was scheduled on the Activity Calendar, the card game activity that R1 would like to play attracts only a few residents to participate as it did on prior weeks it was scheduled and played. Further, the card game was bought and owned by the facility but it was always R1 who would like to keep it after every game which is why it was on R1's room.

LPA's interview with another staff also revealed that it was explained to R1 by the Activity Director hours prior to the allotted time for the card activity game that the card activity game will be changed to another activity to encourage more residents to participate and R1 agreed. LPA's interview with seven (7) residents or 10% of the current census revealed that seven (7) out of seven (7) residents participate in the Activity of their choosing and no staff or anyone stop them from participating nor anyone forced them to participate in any Activity that they do not like.

Based on the information gathered during this visit, the allegation is deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

LIC9099 (FAS) - (06/04)

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