<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197606682
Report Date: 09/11/2024
Date Signed: 09/11/2024 01:13:51 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/26/2024 and conducted by Evaluator Regina Cloyd
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20240826155915
FACILITY NAME:BROOKDALE SANTA MONICA GARDENSFACILITY NUMBER:
197606682
ADMINISTRATOR:RALPH BALBINFACILITY TYPE:
740
ADDRESS:851 2ND STTELEPHONE:
(310) 393-2260
CITY:SANTA MONICASTATE: CAZIP CODE:
90403
CAPACITY:128CENSUS: 66DATE:
09/11/2024
UNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Executive Director II Mia NakanatzuTIME COMPLETED:
01:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
The facility did not provide comfortable accommodations to residents in care.
The facility did not provide quality food.
The facility did not provide the correct refund amount.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 09/11/24, Licensing Program Analyst (LPA) Regina Cloyd conducted a subsequent complaint investigation at the above facility to deliver findings. LPA met with Executive Director II Mia Nakanatzu. The investigation consisted of the following: During today’s visit, LPA conducted a second interview with one Caregiver and interviewed the Operations Specialist, Caregiver, and the Concierge.

On 09/04/2024 Licensing Program Analysts (LPA) Regina Cloyd and Hollie Enriquez conducted a complaint investigation at the above facility to address the following allegations. LPAs met with Administrator Paloma Keitelman and explained the purpose of the visit. Executive Director II Mia Nakanatzu joined us later. The investigation consisted of the following: During today’s visit, LPAs interviewed residents and staff, reviewed the register of residents, personnel reports (LIC 500), accounting documents, maintenance documents and two resident records. Due to insufficient time, the above allegation needed further investigation. A copy of that report was reviewed and left with the Executive Director II Mia Nakanatzu. Continue to LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) -40-7397
LICENSING EVALUATOR NAME: Regina CloydTELEPHONE: 323-981-7155
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2024
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 11-AS-20240826155915
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: BROOKDALE SANTA MONICA GARDENS
FACILITY NUMBER: 197606682
VISIT DATE: 09/11/2024
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
Regarding the allegation "The facility did not provide comfortable accommodations to residents in care," it is being alleged that complaints about daytime noise (toilet pipelines) repairs to unit #201 were ignored. It is also being alleged that complaints about nighttime noise by caregiver services on the third floor (above Resident 1 (R1) and Resident 2’s (R2) room) were ignored. Four (4) out of eight (8) resident interviews, not including R1 and R2, indicated that they lived at the facility between August-September 2023. Three (3) out of four (4) residents who lived in the facility between August-September 2023 recall the pipe repair work causing some degree of noise that was at times a little annoying but not bothersome to require filing a complaint. Of the residents who recalled the construction noise, all three (3) indicated that the facility warned the residents of the repair work, and the work did not go into the night to disturb sleep. One (1) out of four (4) residents who lived in the facility between August-September 2023 did not recall the pipe repair work nor any construction causing some degree of noise. Two out of three staff members who were at the facility during the construction indicated that they did not receive any resident complaints concerning noise. Record reviews indicate that an email was sent from the facility’s Operations Specialist to R1 and R2’s daughter stating, “let me know if there is anything we can do to convince him to stay”. Phone interview with the Operations Specialist indicated that R1 and R2 was offered temporary relocation within the facility but could not guarantee complete silence since they lived in a community. Operations Specialist declined R1’s request to be relocated to a hotel.

Regarding the allegation "The facility did not provide comfortable accommodations to residents in care,” based on interviews and record review, the Department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, as a result, the allegation is Unsubstantiated.


Allegation

Regarding the allegation "the facility did not provide quality food,” it is being alleged that Styrofoam containers were used to serve hot meals during the facility repairs caused gout and resulted in Resident 1 (R1) being hospitalized on 09/21/23 for eleven days and in rehabilitation for four weeks. Record review reveals that R1’s admission agreement was executive on 08/14/23. It also reveals that R1’s previous Health Care Center Order Summary (07/27/23), addendum for additional personalization (07/31/23), physician’s report (08/10/23), admission record (08/17/23), and personal service plan (08/17/23) references a gout diagnosis.

Continue to LIC9099-C.

SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) -40-7397
LICENSING EVALUATOR NAME: Regina CloydTELEPHONE: 323-981-7155
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20240826155915
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: BROOKDALE SANTA MONICA GARDENS
FACILITY NUMBER: 197606682
VISIT DATE: 09/11/2024
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
Four (4) out of eight (8) residents interviewed lived at the facility between August and September 2023. Three (3) out of four (4) residents who lived at the facility between August and September 2023 reported that there was a time that the kitchen may have used Styrofoam dishware for a short period during the pipe repair, but it did not impact the normal food quality. Eight (8) out of eight (8) residents interviewed reported that the food is usually on regular dishware but may be occasionally on Styrofoam, depending on the food and where the resident will dine. All eight (8) out of eight (8) residents reported that the normal food quality and choices were unaffected by when kitchen staff served meals in Styrofoam dishware. Eight (8) out of eight (8) residents reported that the food was good. Interview with the Chef indicated that cold lunches were served for lunch and hot boxes was used to keep hot meals warm during repairs. Also, the Chef indicated that the dining hall was only closed for about a week in the middle of August 2023. Finally, the Chef indicated that each resident has a microwave and refrigerator in his/her room. Interview with two Sous Chef indicated that no complaints were received concerning the temperature of the hot meals. Interview with the Executive Director II indicated that staff follows the Physician’s Diet Order. Record review reveals that R1 was on a regular diet with thin liquids dated 08/10/23. Regarding the allegation “the facility did not provide quality food," based on record reviews and interviews, the Department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, as a result, the allegation is Unsubstantiated.
Allegation
Regarding the allegation “the facility did not provide the correct refund amount,” it is being alleged that Resident #1 (R1) paid $3,853.00 and Resident #2 (R2) paid $3,043.00 for August services. It is being alleged that the amount was corrected the following month but the facility never reimbursed $810.00 to R1. Record review reveals that the additional funds remained on R1’s account. Interview with the Executive Director II indicated that a refund was not promised but that the money would remain on the account. Record review reveals that the additional charges were applied to the credit. The additional charges are associated with R1’s contract agreement: Terms and Termination in Section IV(B), Community Fee Rates in Section III(A)(3), and Addendum to the Residency Agreement Permanent Basic Service Rate Discount – Automatic Withdrawal. Regarding the allegation “the facility did not provide the correct refund amount," based on record reviews and interviews, the Department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, as a result, the allegation is Unsubstantiated. No deficiencies were cited. An exit interview was conducted. A copy of this report was reviewed and provided to the Executive Director II Mia Nakanatzu.
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) -40-7397
LICENSING EVALUATOR NAME: Regina CloydTELEPHONE: 323-981-7155
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3