191221839-3-21-2023-28-AS-MVAO-CQMUBR-20230406152645

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191221839
Report Date: 03/21/2023
Date Signed: 03/21/2023 01:43:27 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,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/07/2023 and conducted by Evaluator Troy Agard

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230207091758

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:	03/21/2023
		UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Besty Davis		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Resident was assaulted while in care
Facility staff did not safeguard resident's personal belongings

INVESTIGATION FINDINGS:

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On 03/21/2023 Licensing Program Analyst (LPA) Troy Agard conducted a subsequent complaint investigation at the above facility to address the following allegation(s). LPA Agard was met by Besty Davis, Administrator. LPA explained the purpose of this visit was to gather information and deliver findings for this complaint.

The investigation consisted of the following: On 02/12/2023, LPA Agard conducted a 10-day visit, toured the physical plant and requested documents. LPA Agard requested the following documents: 1) staff and resident roster, 2) incident reports from the past 30 days and 3) R1’s physician report. All documents were received at the time of visit. On 03/21/2023, LPA Agard conducted interviews with residents, staff and a witness. LPA delivered findings on the same day.

Cont. on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 400-7109
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2023

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 28-AS-20230207091758

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: BROADVIEW RESIDENTIAL CARE CENTER	FACILITY NUMBER: 191221839
	VISIT DATE: 03/21/2023

NARRATIVE

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The investigation revealed the following: Regarding the allegation… Resident was assaulted while in care. It’s being alleged a resident in care was possibly drugged and raped during the night. LPA Agard interviewed 2 staff out of 29. 0 out of 2 confirmed the allegation. S1 states, R1 has presented with a recent onset of memory loss, confusion and delusions. “R1 was just diagnosed with a cognitive impairment so that is where all this is coming from. R1 complained that staff were stealing their things. I would go to the room and find the missing items. The night that resident came back from a (offsite) home visit, they completed their activities of daily living independently, forgot to put on their undergarments and alleged they had been assaulted because of this. Ultimately, R1 was not reporting correctly. R1 requested for a rape kit but the hospital denied it because they did not observe any signs or indications of rape.”

During interviews with residents, LPA Agard attempted interviews with 6 out of 63 residents. 0 out of 5 confirmed the allegation. R1 was unable to be interviewed due to resident’s cognitive impairment. All residents interviewed unanimously denied the allegation. Citing only positive experiences while living at the facility. R2 states, “I love living here. So does my spouse. They love it too. The staff treat me very nice. I don’t know about that allegation. Never heard about that but could you please tell S1 that we love it here.” R3 states, “It’s absolutely wonderful here. The staff are very caring, they keep the place clean and take care of me just the way I like. I’m very fortunate to be here. I don’t know about anyone being assaulted.” LPA interviewed one witness that also denied the allegation. W1 states, “R1 was taken to the hospital and was checked by the Obstetrician Gynecologist (OBGYN) during the hospitalization. They told us there was no signs of R1 being attacked.”

Regarding the allegation… Facility staff did not safeguard resident's personal belongings. It’s being alleged items and clothing has been stolen from a resident in care.” During interviews with staff, 0 out of 2 confirmed the allegation. S1 states, “no one was stealing from R1. They would report stuff missing, but I would find it. Many of the things they reported missing had all been there. We found so many things that were doubles and triples.” S2 states, “Many residents might say something is missing but is just misplaced and is usually in their room.”

cont on 9099C

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 400-7109
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20230207091758

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: BROADVIEW RESIDENTIAL CARE CENTER	FACILITY NUMBER: 191221839
	VISIT DATE: 03/21/2023

NARRATIVE

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During an interview with residents, 0 out of 5 confirmed the allegation. R1 was unable to be interviewed. All residents interviewed unanimously denied the allegation. R2 states, “My belongings are safe. People give me a lot of things all the time. I’ve never had anything go missing.” R3 states, “Absolutely. I never had an issue with my stuff going missing.” R5 states, “My personal belongings have always been safe. We don’t have theft issues here.” LPA interviewed one witness that also denied the allegation. W1 states, “The truth is, I know R1 always says things were disappearing, but I can tell you they lose everything. For example, R1 would say someone took their phone. Not remembering they gave their phone to me to charge. This continues even while they live with me now.”

During a record review, LPA observed the following: an incident report dated 10/14/2022 stating R1 had been experiencing signs of paranoid behavior, reporting staff wanting to harm them, and steal from them. LPA reviewed a physician report dated for 12/09/2021 that identified a mild cognitive impairment in R1. On 02/05/2023, R1 was admitted to Keck Medicine of the University of Southern California for signs and symptoms of dementia and alleged assault. Resident was diagnosed with an Acute Urinary Tract Infection (UTI), confusion and delusions. Most recently, R1 had an evaluation on 03/09/2023 due to residents’ recent changes in health condition. The assessment identifies a diagnosis of moderate dementia with other behavioral disturbances, and a decline in cognition complicated by anxiety, depression and psychosis.

Based on LPA’s record review and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation(s) may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are unsubstantiated.

An exit interview was conducted, and a copy of the report was given.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 400-7109
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2023

LIC9099 (FAS) - (06/04)

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