191221839-9-14-2021-28-AS-SCOL-CDAMQ7-20220408094812

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191221839
Report Date: 09/14/2021
Date Signed: 09/14/2021 02:46:15 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
09/03/2020 and conducted by Evaluator David Sicairos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20200903103643

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: 60	DATE:	09/14/2021
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Betsy Davis; Administrator		TIME COMPLETED:	03:02 PM

ALLEGATION(S):

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Facility is in disrepair.
Resident has not been adequately hydrated resulting in dehydration.
Staff continued to provide discontinued medication to the resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) David Sicairos conducted an subsequent unannounced complaint visit regarding the above stated allegations. LPA met with Administrator Betsy Davis and explained the reason for the visit.

The investigation revealed the following: during the intial televisit conducted on 09/11/20, LPA interviewed the Administrator. LPA also requested via email copies of documents for Resident #1 (R1) such as Physician's Report, Identification and Emergency Information, Resident Appraisal, Progress Notes, MAR's for the last 3 months, and any recent Incident Reports. During today's visit, LPA toured the facility including common areas and interviewed Staff #1 - Staff #5 and Resident #1 - Resident #9. LPA also interviewed Dr. Hoang over the phone.

The investigation revealed the following: in regards to the allegation "facility is in disrepair", it is alleged that the common areas in the facility do not have air conditioning and the facility will get too hot. During today's visit, LPA toured the common areas with the Administrator and observed the common area thermostats in the first floor read between 75F - 76F and 72F - 77F in the 2nd floor. (CONTINUED ON 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: David Sicairos	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021

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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Control Number 28-AS-20200903103643

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: BROADVIEW RESIDENTIAL CARE CENTER	FACILITY NUMBER: 191221839
	VISIT DATE: 09/14/2021

NARRATIVE

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9 out of 9 residents interviewed indicated that they feel that the temperature in the common areas of the facility is always at a comfortable temperature. Residents interviewed also indicated that they have individual A/C units in their rooms and they are able to adjust the temperature and turn on and off the unit as they please. 5 out of 5 staff members interviewed indicated that the facility is always set at a comfortable temperature. Staff members indicated that they will assist residents with their A/C units and room temperature adjustments as necessary. LPA obtained a "Temperature Log" for R1 dated 09/03/20 - 09/11/20 monitoring R1's room temperature. Room temperature ranged from 72F - 76F. Therefore there was insufficient evidence to corroborate with this allegation.

In regards to the allegation "resident has not been adequately hydrated resulting in dehydration", it is alleged that R1 was moved to the first floor closer to the nurse’s station so that they could monitor her water intake. Resident was offered to be moved downstairs, however R1's Responsible Party declined. Reporting Party is concerned that the residents are not being properly hydrated. 9 out of 9 residents interviewed indicated that the facility always has drinking water available for residents. Residents indicated staff members will pass out pitchers of waters with ice to all residents throughout the day as needed. Residents are also provided with liquids during each meal. 5 out 5 staff members interviewed indicated that residents are provided with pitchers of waters throughout the day. Residents can request as much water as they want. Staff members indicated that they will prompt and remind residents to drink fluids as they pass out meals and water. During today's visit, LPA observed staff members passing out pitchers of waters to residents. LPA obtained a "Fluid Intake Log" for R1 dated from 09/03/20 - 09/11/20 monitoring R1's water intake. Therefore there was insufficient evidence to corroborate with this allegation.

In regards to the allegation "staff continued to provide discontinued medication to the resident", it is alleged that facility staff found some R1's discontinued pills after being discharged from the hospital and administered them to the resident. On 08/03/20, Clobazam was put "on hold" for R1 by Dr. Hoang. R1 was hospitalized between 08/24/20 - 08/26/20. Upon discharge from the hospital, Clobazam 10mg was listed as part of the discharge medication orders for R1. Based on Doctor's Orders received from the hospital, facility staff administered Clobazam to R1 on 08/27/20. R1 then refused the medication on 08/28/20. Around 6:30pm on 08/28/20, Administrator received Doctor's Orders from Dr. Harutunian instructing facility to discontinue use of Clobazam on R1. Facility proceeded to discontinue medication based on doctor's written orders. R1 has not been given Clobazam since the date facility received written doctor's orders to discontinue the medication. Therefore there was insufficient evidence to corroborate with this allegation.

Based on statements and interviews conducted with staff, residents, review of resident files and facility file records, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview held, and a copy of this report was provided.

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: David Sicairos	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021

LIC9099 (FAS) - (06/04)

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