191221839-3-29-2022-28-AS-MVAO-CHEQ2Y-20220818114755

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191221839
Report Date: 03/29/2022
Date Signed: 03/29/2022 02:05:50 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, 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
03/23/2022 and conducted by Evaluator Christine Wong

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220323161606

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: 59	DATE:	03/29/2022
		UNANNOUNCED	TIME BEGAN:	10:35 AM
MET WITH:	Betsy Davis		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are inappropriately restraining the residents while in care

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Christine Wong conducted an initial complaint investigation for the above allegation listed aboved. LPA met wtih the receptionist Arlene Cirera and explained the purpose of the visit. Then LPA met wtih Administrator Betsy Davis and assisted witht visit.

The investigation consisted of the following: LPA interviewd administrator, four staff (S1-S4) and six residents (R1-R6) and obtained resident and staff roster, resident sign in out sheet from March 11 to March 25, 2022, residetns exercise attendence sheet and outbreak line list and incident reports.

The investigation revelaed of the following: Allegation "Staff are inappropriately restraining the residents while in care." LPA interviewed six residents and six out of six residents denied the allegation. They reported that they were able to go out during the pademic. They never felt the facility were inapproproately restraining them.
(See LIC 9099C for continuation)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2022

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 28-AS-20220323161606

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: 03/29/2022

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

The residents reported they can still go to their doctor appointments and families can come and visit them during the pandemic. LPA interviewed staff and all denied the allegation. Staff reported residents have their right to go outside of their rooms and the building if they have no symptoms with good health. Administrator reported two weeks ago, the facility had another outbreak (Norovirus) in the facility and facility consulted with the Department of Public Health and its better to lock down the facility due to the virus is very contagious as they have about 8 residents and 2 staff were getting infected. Currently the facility has been cleared from the outbreak. LPA also reviewed the resident sign in and out sheet and residents were able to go in and out from the building. LPA also reviewed the exercise class attendance sheet and residents do attend the exercise class during the time of the outbreak which is meant that resident were not locked in the room.

Based on statements and interviews conducted with staff, residents and record reviews, 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 allegation is UNSUBSTANTIATED.

Exit interview held, and a copy of this report and appeal right was provided to the administrator Batsy Davis.

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 2