197606682-8-19-2026-11-AS-UCOL-DY5TMK-20260921145116

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606682
Report Date: 08/19/2026
Date Signed: 08/19/2026 01:16:09 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/12/2026 and conducted by Evaluator Regina Cloyd

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20260812105005

FACILITY NAME:	BROOKDALE SANTA MONICA GARDENS		FACILITY NUMBER:	197606682
ADMINISTRATOR:	RALPH BALBIN		FACILITY TYPE:	740
ADDRESS:	851 2ND ST		TELEPHONE:	(310) 393-2260
CITY:	SANTA MONICA	STATE: CA	ZIP CODE:	90403
CAPACITY:	128	CENSUS: 64	DATE:	08/19/2026
		UNANNOUNCED	TIME BEGAN:	11:22 AM
MET WITH:	Amanda Monroy		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff increased the resident’s fees without providing the required prior notice.
Staff falsified the resident's records.

INVESTIGATION FINDINGS:

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On 08/19/26, Licensing Program Analyst (LPA) Regina Cloyd conducted a subsequent visit to gather information regarding the above allegations. LPA met with the Executive Director Amanda Monroy.

Investigation consisted of the following: On 08/18/26, the Department obtained Personnel Record, Register of Residents, and Residents #1 - #6 Records. LPA interviewed Staff #1 – 5, Residents #2 - #6, and Witness #1. LPA left a voicemail for Witness #3. On 08/19/26, LPA interviewed Staff #1, #6 and Witnesses #2, #4 - #5.

Investigation revealed the following:
Allegation: Staff increased the resident’s fees without providing the required prior notice. It is alleged Resident #1 (R1) received an updated plan of care and the bathroom assistance fees (increased from $262 to $918) were retroactive to April 2026.
Continue to LIC9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2026

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 11-AS-20260812105005

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: BROOKDALE SANTA MONICA GARDENS	FACILITY NUMBER: 197606682
	VISIT DATE: 08/19/2026

NARRATIVE

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Record review revealed the following: R1’s Admission Agreement (07/22/21) revealed the community will provide (60) days written notice of any change in the rates for Basic Services, Personal Services, Select Services, Therapeutic Services or any other fees listed in this agreement. Additionally, we may offer or require a change in the Personal Service Plan when we determine additional services are requested or required. When such a change in services occurs and alters your personal service plan, the associated fees as referenced in Exhibit A and detailed in Exhibit Z, will be charged to you immediately after written notice of change in services is provided. Review of Exhibit Z (04/28/26) revealed the new charge ($918) is based on bathroom assistance that includes pulling up and down pants, handling toilet paper, wiping, changing protective undergarments and getting onto and off of toilet. Review of Assessment Summary (04/28/26) revealed the price was effective on 04/28/26.
Interviews revealed the following: Interview with the Executive Director (S1) indicated S1 and the Health & Wellness Director (S6) met with R1 on 04/28/26 and provided R1 with the assessment summary and updated personal service plan. On 07/01/26, a second meeting was held and R1 indicated R1 wanted to attempt to meet R1’s own toileting needs. A two-week trial was provided. On 07/05/26, R1 emailed S1 indicating R1 could not complete toileting needs. S1 and S6 indicated caregivers have been providing bathroom assistance since 04/28/26. S6 indicated the assessment summary and personal service plan was provided on 04/28/26. S1 indicated R1 is not being charged the maximum amount for the bathroom services R1 receives. S1 indicated R1 was also provided with a $500 discount. Four out of four witnesses (W1 – W2, W4 – W5), responsible parties, indicated the invoice is accurate and there has been no retroactive charges.

Regarding the allegation, “Staff increased the resident’s fees without providing the required prior notice,” based on record review and interviews, the preponderance of evidence standard has NOT been met, therefore the above allegation(s) is found to be unsubstantiated. Although the allegation 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 allegation is unsubstantiated.

Allegation: Staff falsified the resident's records.
It is alleged Resident #1 (R1) has not had a change of condition since admission but was presented with an updated plan of care with increased fees. Record review revealed the following: R1's Physician’s Report (2021) revealed R1 does not have bladder or bowel impairment and R1 is able to care for own toileting needs. Continue to LIC9099-C.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2026

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20260812105005

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: BROOKDALE SANTA MONICA GARDENS	FACILITY NUMBER: 197606682
	VISIT DATE: 08/19/2026

NARRATIVE

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R1’s Personal Service Plans (08/21, 11/21, 02/22) revealed R1 needs help in the bathroom. R1’s Personal Service Plan (2023) revealed R1 needs help in the bathroom and is incontinent of bladder. A caregiver will continue to assist resident with completing toileting tasks. R1 has no bowel nor bladder incontinence but uses incontinence products per preference. R1's Physician’s Report (2024) revealed R1 has bladder impairment (frequently) and is unable to meet toileting needs. R1’s Personal Service Plan (10/2024) revealed R1 needs assist with washing up (includes showering) after accidents, changing clothes, laundering soiled clothes and linens. R1 is incontinent of bladder. Personal Service Plan (04/2025) revealed R1 does not require bathroom assistance. R1 is incontinent of bladder. Personal Service Plan (10/2025) revealed R1 is to be reminded to change protective undergarments as needed. R1 is incontinent of bladder.
R1’s Medical Assessment (2026) revealed R1 is bladder incontinence. Personal Service Plan (2026) revealed R1 needs help in the bathroom and is incontinent of bladder.
Interviews revealed the following: Interview with the Executive Director (S1) indicated R1 has a history of refusing services but still receiving the care. On 04/28/26, S1 and the Health & Wellness Director (S6) met with R1 to provide an updated personal service plan. On 07/01/26, a second meeting was held and R1 indicated R1 did not need bathroom assistance but needed staff to wheel R1 into the bathroom and ensure all bathroom items were reachable. The facility gave R1 two weeks to complete the bathroom tasks but R1 still needed the care services. During the trial, S1 learned that the caregivers were still assisting R1 with incontinent care in the bed at night and in the mornings plus changing the bed linen. On 07/05/26, R1 indicated that the bathroom tasks were too much. Five out of five staff interviews (S1, S2, S4, S5, S6) indicated R1 receives toileting assistance. S5 indicated R1 has always needed more care. S6 indicated R1 really needs the maximum bathroom assistance. Five out of five resident interviews (R2 – R6) indicated they receive toileting assistance. Four out of four witnesses (W1 – W2, W4 – W5), responsible parties, indicated the plan of care is accurate.

Regarding the allegation, “Staff falsified the resident's records, ” based on record review and interviews, the preponderance of evidence standard has NOT been met, therefore the above allegation(s) is found to be unsubstantiated. Although the allegation 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 allegation is unsubstantiated.

No deficiencies cited.
An exit interview was conducted, and a hard copy of this report was provided to the Executive Director Amanda Monroy.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2026

LIC9099 (FAS) - (06/04)

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