197606301-2-25-2025-28-AS-RORN-DEVL8Y-20250318083240

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606301
Report Date: 02/25/2025
Date Signed: 02/25/2025 04:36:00 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
02/21/2025 and conducted by Evaluator Erik Zaragoza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250221115902

FACILITY NAME:	BROOKDALE MONROVIA		FACILITY NUMBER:	197606301
ADMINISTRATOR:	BALBIN, RALPH		FACILITY TYPE:	740
ADDRESS:	201 E FOOTHILL BLVD		TELEPHONE:	(626) 301-0204
CITY:	MONROVIA	STATE: CA	ZIP CODE:	91016
CAPACITY:	75	CENSUS: 66	DATE:	02/25/2025
		UNANNOUNCED	TIME BEGAN:	01:46 PM
MET WITH:	Logan Harrison - Executive Director		TIME COMPLETED:	04:55 PM

ALLEGATION(S):

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Staff speaks inappropriately to resident in care
Staff does not ensure that residents' incontinence needs are being met
Staff does not assist residents, when responding to call button

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Erik Zaragoza conducted an unannounced initial complaint visit to investigate the allegations listed above. LPA met with Logan Harrison, Executive Director for the facility, and explained the purpose of the visit.

The investigation consisted of the following: LPA interviewed Staff #1 - 5 (S1 - S5), Residents #1 - 7 (R1 - R7), conducted a tour of the facility, and also obtained the staff and resident rosters, tested a call light pendant of a resident, obtained the police report number for the investigation conducted by the Monrovia Police Department, and also reviewed the staff file of Staff #6 (S6). LPA attempted to interview Staff #6 however they had recently resigned.

The investigation revealed the following: In regards to the allegation that "Staff speaks inappropriately to resident in care," it is alleged that S6 had been making inappropriate and belittling remarks towards R1.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Erik Zaragoza	TELEPHONE: (323) 981-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2025

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-20250221115902

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: BROOKDALE MONROVIA	FACILITY NUMBER: 197606301
	VISIT DATE: 02/25/2025

NARRATIVE

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During interviews with the residents, six (6) out of seven (7) did not corroborate the allegation. One resident interviewed stated that staff are respectful towards them and everyone else in the facility. Another resident interviewed stated that they have never heard of staff making inappropriate or rude remarks towards anyone else in the facility. During interviews with staff, five (5) out of six (6) interviewed did not corroborate the allegation. One staff interviewed that the Monrovia Police Department conducted their own investigation into the matter and determined that they would be closing the case, and provided LPA with the investigating officer's name and report number. Another staff member stated that they have never witnessed S6 make any inappropriate remarks towards any of the residents of the facility in the past. During record review of S6's file it was revealed that they were suspended pending investigation on 2/13/2025 due to the allegation that she had been treating residents disrespectfully. The executive director of the facility explained that following the facility's investigation into the allegations, they determined that there was no evidence for them and allowed S6 to return to work. S6 however voluntarily resigned today 2/25/2025.

In regards to the allegation that "Staff does not ensure that residents' incontinence needs are being met," it is alleged that staff, particularly S6, and been intentionally refusing to provide incontinence care to the residents including R1. During interviews with the residents, none of them corroborated the allegation. One of the residents explained that they are receiving all of the services that they require at the facility. Another resident interviewed stated that all their needs are met and that staff are always very pleasant when assisting them. During interviews with staff, five (5) out of six (6) did not corroborate the allegation. One of the staff member stated that they have never witnessed S6 or any other staff refuse to provide care to any of the residents. Another staff member interviewed stated that no staff members have ever denied care to any of the residents.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Erik Zaragoza	TELEPHONE: (323) 981-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20250221115902

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: BROOKDALE MONROVIA	FACILITY NUMBER: 197606301
	VISIT DATE: 02/25/2025

NARRATIVE

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In regards to the allegation that "Staff does not assist residents, when responding to call button," it is alleged that S6 had been intentionally going into R1's room to deactivate their call light pendant and leave their room without assisting them. During interviews with residents, none of them corroborated the allegation. One residents stated that they always receive assistance when they use their pendant. Another resident interviewed stated that it sometimes takes time to receive assistance when it is busy for caregivers, but they ultimately always receive assistance. During interviews with staff, five (5) out of six (6) interviewed did not corroborate the allegation. One of the staff members stated that they have never witnessed S6 or any other staff intentionally turning off or ignoring the call lights. Another staff member stated that they were not aware of any staff members refusing to respond to call lights or turning them off when residents use them to request assistance.

Based on statements and interviews conducted with staff, clients, review of client 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: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Erik Zaragoza	TELEPHONE: (323) 981-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2025

LIC9099 (FAS) - (06/04)

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