197606301-9-26-2023-28-AS-RORN-CW9LEN-20231003084147

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606301
Report Date: 09/26/2023
Date Signed: 09/26/2023 06:05:16 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
09/18/2023 and conducted by Evaluator Bonnie Tao

COMPLAINT CONTROL NUMBER: 28-AS-20230918163747

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: 57	DATE:	09/26/2023
		UNANNOUNCED	TIME BEGAN:	08:25 AM
MET WITH:	Logan Harrison, administrator		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Staff did not clean resident's room.
Facility is not adequately staffed to meet the needs of the residents in care.
Unqualified staff are performing glucose testing for residents in care.
Facility staff are not properly trained.
Staff did not ensure that a resident was administered medication.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tao conducted an unannounced 10 day complaint visit to this facility. Upon arriving at the facility, LPA met with Administrator, Logan Harrison. LPA explained the purpose of today’s visit is to discuss the above-mentioned allegations.

The investigation consisted of resident interviews, staff interviews, facility tours, and review of facility records. LPA obtained resident roster, staff roster, and residents’ facility files.

The investigation revealed the following:
In regard to allegation “staff did not clean resident's room," it was alleged that staff did not clean resident’s room who had dog(s). Seven (7) out of seven (7) residents interviewed could not corroborate the allegation. Two (2) residents interviewed had a dog and five (5) residents interviewed did not have pets. Resident interviews revealed that staff clean resident's rooms daily and housekeeping staff conducted deep cleaning weekly. (-continued in LIC 9099 C-)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

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 3

Control Number 28-AS-20230918163747

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: BROOKDALE MONROVIA	FACILITY NUMBER: 197606301
	VISIT DATE: 09/26/2023

NARRATIVE

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In regard to allegation “facility is not adequately staffed to meet the needs of the residents in care," it was alleged that facility was understaffed which caused bed bound resident was not properly attended for resident’s need and residents would sit on soiled diaper for long period of time. Seven (7) out of seven (7) residents interviewed could not corroborate the allegation. Four (4) of those seven (7) residents interviewed were using briefs or diapers. Residents’ interviews revealed staff provided the cares that residents’ needs, they did not sit on soiled diaper for long period of time, and their cares/needs were met. All six (6) staff interviewed denied the allegation. Administrator stated no resident residing at the facility was bed bound. Staff interviews revealed that no resident was bed bound. Staff would attend to residents who needs assistance and change their soiled diapers in 5 - 10 minutes. LPA toured to residents’ room who using briefs and diapers. LPA did not smell foul odor and was not aware of residents who sit on soiled diapers. Therefore, staff had met residents’ cares and needs.

In regard to allegation “unqualified staff are performing glucose testing for residents in care," it was alleged that staff who are not medical professional had conducted glucose testing for residents. Seven (7) out of seven (7) residents interviewed could not corroborate the allegation. Resident interviews revealed that residents would prick their fingers with lancet and drew blood by themselves. Staff would prepare and clean up after residents’ glucose testing. All six (6) staff interviewed denied the allegation. Staff interviews revealed that residents’ glucose testing was conducted by residents and staff only assisted on preparing the set up and clean up after the test. Staff file review revealed facility had policy on medication administration and training on blood glucose monitoring to staff. Therefore, staff did not perform glucose testing for residents.

In regard to allegation “facility staff are not properly trained," it was alleged that staff are not properly trained for administer injection medication to resident. Seven (7) out of seven (7) residents interviewed could not corroborate the allegation. Resident interviews revealed none of the residents were on injectable medication. All six (6) staff interviewed could not corroborate the allegation. Staff interviews revealed no resident was on injectable medication. Per staff file review, since no resident is on injectable medication, no training on injectable medication was needed. Therefore, facility did not fail to properly trained staff on injection medication.

(-continued in LIC 9099 C-)

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20230918163747

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: BROOKDALE MONROVIA	FACILITY NUMBER: 197606301
	VISIT DATE: 09/26/2023

NARRATIVE

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In regard to allegation “staff did not ensure that a resident was administered medication," it was alleged that resident did not receive resident’s injectable medication. Seven (7) out of seven (7) residents interviewed could not corroborate the allegation. Resident interviews revealed that residents did not have injectable medication. All six (6) staff interviewed could not corroborate the allegation. Staff interviews revealed that no resident residing at the facility had injectable medication. File review revealed no resident was on injectable medication. As mentioned above, per staff file review, no training on injectable medication was provided and no resident was on injectable medication. LPA toured to med room and did not observe any injectable medication in place. Therefore, staff did not fail to administer resident’s injectable medication since no resident was on injectable medication.

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.

An exit interview was conducted with Administrator. A hard copy of the report and appeal rights were provided.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

LIC9099 (FAS) - (06/04)

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