197606682-3-5-2025-11-AS-JHAD-DFD28S-20250402171048

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606682
Report Date: 03/05/2025
Date Signed: 03/05/2025 02:57:57 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
02/27/2025 and conducted by Evaluator Perry Scott

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20250227161639

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: 62	DATE:	03/05/2025
		UNANNOUNCED	TIME BEGAN:	10:31 AM
MET WITH:	Paloma Keitelman		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff do not respond in a timely manner to residents' calls for assistance.
Staff do not ensure that residents are provided with planned daily activities.
Staff do not maintain a facility activity calendar.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 3/5/25, at 10:00am, the department conducted an initial complaint visit to the facility and was greeted by Paloma Keitelman, Business Office Manager. The department explained the purpose of this visit is to gather information about the complaint, gather facility files, and deliver findings for the allegations mentioned above.

The investigation consisted of the following: The Department investigated the allegations mentioned in this complaint; and conducted interviews with staff (S1-S4) and residents (R1-R8) from 10:00am-2:00pm. The department received the following: Resident Roster (Dated: No Date), Staff Roster (Dated: 02/27/2025), Activities Calendar (Dated: January 2024-March 2025), and In-Service Trainings (Dated: 11/2024- 2/2025) from the facility.

The investigation revealed the following: Allegation #1-Staff do not respond in a timely manner to residents' calls for assistance.

Page 1 of 4

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Perry Scott	TELEPHONE: (707) 849-2315
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2025

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 4

Control Number 11-AS-20250227161639

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: 03/05/2025

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

The details of the complaint alleged that the staff does not respond promptly to the residents call button. It is alleged that residents must wait up to one hour for assistance when they push the call button for assistance. On 3/5/25, from 10:00am-2:00pm, the department interviewed staff (S1-S4) and residents (R1-R8) regarding the allegation. Staff (S1-S4) denied the allegation that the Staff do not respond in a timely manner to residents' calls for assistance. Staff (S1-S4) stated that they do respond in a timely manner when residents ask for assistance. All staff stated that the average wait time for assistance is 15 minutes or less.

The Department interviewed residents (R1-R8) about the allegation and 5 of 8 residents that were interviewed denied the allegation that Staff do not respond in a timely manner to residents' calls for assistance. The majority of the residents interviewed (5 of 8) stated that the staff does respond in a timely manner if they need assistance. They state on average it takes about 15 minutes or less to get help and are satisfied with the services provided.

The Department reviewed the staff roster (Dated: 02/27/2025) and observed that there is a sufficient number of staff to meet the needs of the residents. Additionally, the department reviewed the In-Service Trainings (Dated: 11/2024- 2/2025) and observed that the staff had the required trainings in personal rights of residents.

Based on interviews and records reviewed, there is insufficient evidence to support the allegation that the Staff do not respond in a timely manner to residents' calls for assistance. 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, therefore the allegation is Unsubstantiated.

Allegation #2- Staff do not ensure that residents are provided with planned daily activities.

The details of the complaint alleged that the facility, for the past two months, is not ensuring that the residents have planned activities because there is not an activities director. On 3/5/25, from 10:00am-2:00pm, the department interviewed staff (S1-S4) and residents (R1-R8) regarding the allegation. Staff (S1-S4) denied the allegation that the Staff do not ensure that residents are provided with planned daily activities. All staff (S1-S4) stated that the facility does have daily activities for the residents to participate in, in the absence of a current activities’ director. S1 stated the facility is in the process of hiring a new activities director, and have two candidates in mind, and they are awaiting a final decision from the in-coming executive director.

Page 2 of LIC9099-C

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Perry Scott	TELEPHONE: (707) 849-2315
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 11-AS-20250227161639

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: 03/05/2025

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

The Department interviewed residents (R1-R8) about the allegation and 7 of 8 residents that were interviewed denied the allegation that Staff do not ensure that residents are provided with planned daily activities. The residents that were interviewed stated that the facility does have planned activities each day for the residents to participate in.

The department reviewed the activities calendars (Dated: January 2024-March 2025) and observed that the facility has planned activities for the residents each day. Some of the activities include morning and afternoon exercise classes, bridge games, Mardi Gras celebration, shopping trips, silk scarf painting, women’s club meetings, St. Monica’s Legion of Mary Communion Service, jewelry making, mosaics arts and crafts, and a host of other activities for each day of the week. Additionally, the department reviewed the In-Service Trainings (Dated: 11/2024- 2/2025) and observed that the staff has trainings in inviting, assisting, and encouraging residents to participate in activities offered by the facility.

Based on interviews and records reviewed, there is insufficient evidence to support the allegation that the Staff do not ensure that residents are provided with planned daily activities. 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, therefore the allegation is Unsubstantiated.

Allegation #3- Staff do not maintain a facility activities calendar.

The details of the complaint alleged that the facility does not have a current activity calendar because there is not a current activities director. On 3/5/25, from 10:00am-2:00pm, the department interviewed staff (S1-S4) and residents (R1-R8) regarding the allegation. Staff (S1-S4) denied the allegation that the Staff do not maintain a facility activities calendar. All staff (S1-S4) stated that the facility does have an activities calendar and it is in the lobby of the facility on the wall. Additionally, they state that there are hand fliers with all the activities for each month on the table below the wall mounted calendar, so that residents can take it with them to have as a reminder.

The Department interviewed residents (R1-R8) about the allegation and 7 of 8 residents that were interviewed denied the allegation that Staff do not maintain a facility activities calendar. The majority of residents that were interviewed (7 of 8) stated that the facility does have an activities calendar and they are aware of the activities provided by the facility.

Page 3 of LIC 9099-C

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Perry Scott	TELEPHONE: (707) 849-2315
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 11-AS-20250227161639

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: 03/05/2025

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

The Department reviewed the Activities Calendar (Dated: March 2025) and observed that the facility does in fact have planned activities for the residents to participate in each day of the month. On todays visit the department observed that the residents were participating in the Exercise B-Fit located in the activities room. Additionally, the department observed that there is a planned lunch outing, current events discussion, and a Happy Hour performance by a band later in the evening.

Based on interviews, observations, and records reviewed, there is insufficient evidence to support the allegation that the Staff do not maintain a facility activities calendar. 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, therefore the allegation is Unsubstantiated.

No citations were issued.

An exit interview was conducted with Paloma Keitelman, Business Office Manager, and a hard copy of this Complaint Investigation Report was provided.

Page 4 of LIC9099-C

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Perry Scott	TELEPHONE: (707) 849-2315
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2025

LIC9099 (FAS) - (06/04)

Page: 4 of 4