197606682-10-14-2021-11-AS-EMAZ-C8DMGH-20211102093558

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606682
Report Date: 10/13/2021
Date Signed: 10/14/2021 08:04:24 AM

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 DR #100
MONTERY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/24/2020 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20200724100218

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: 67	DATE:	10/13/2021
		UNANNOUNCED	TIME BEGAN:	09:34 AM
MET WITH:	Ralph Balbin		TIME COMPLETED:	12:02 PM

ALLEGATION(S):

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Facility charging resident for unneeded services.
Staff is not properly assessing residents.
Facility retains residents with unstageable pressure injuries.
Facility retaining residents that require a higher level of care.

INVESTIGATION FINDINGS:

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On 10/13/21, Licensing Program Analyst (LPA) Ernand Dabuet conducted a subsequent unannounced complaint visit at this facility. LPA met with Executive Director Ralph Balbin and explained the purpose of today's visit is to gather additional information and deliver findings for the allegations mentioned above.

The investigation consisted of the following: LPA inquired questions relevant to the nature of the complaint. An interview with the Executive Director and (4) staff, (8) residents (3) witnesses. LPA reviewed (R1-R5)'s service records and other pertinent documents associated with this complaint. A tour of the facility was conducted on 09/24/21 and 10/06/21.

Evaluation Report continues on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2021

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-20200724100218

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 DR #100
MONTERY PARK, CA 91754

FACILITY NAME: BROOKDALE SANTA MONICA GARDENS	FACILITY NUMBER: 197606682
	VISIT DATE: 10/13/2021

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Facility charging resident for unneeded services.
Details provided indicated the facility charges resident for unneeded services. The complainant claims resident #5 (R5) is overcharged for unnecessary services. An interview with (R5) revealed that he signed a Residency Agreement. The Residency Agreement details what is covered under basic services. Any care services not included are itemized on the Resident Prospect Care Plan. A review of (R5’s) Physician’s Report LIC 602A listed his capacity for self-care and it is aligned with what is on the Resident Prospect Care Plan. (R5) states he is aware of the extra charges listed on Resident Prospect Care Plan and that the facility did not do anything underhanded. An interview with resident #6-#11 (R6-R11) all supported (R5’s) statement and included they do not know any residents being overcharged for unnecessary services. An interview with witnesses #1-#3 (W1-W3), family members for (R1-R3) all claimed they were made aware of all charges in writing during the admission process and stated the facility was transparent about any fees not covered under the basic services. An interview with staff #1-#5 (S1-S5) all verified that each resident goes through an extensive admission process which includes a personal assessment. At the time of agreement signing the resident or the designated representative will review a list of attachments and acknowledgments before the Residency Agreement is signed. (S1-S5) all confirmed there are no residents in this facility that is being charged for superfluous services. Staff #1 (S1) explained the care services at this facility is not in a set package; rather it is offered in separate items based on the resident’s service assessment and these services are listed on the Resident’s Prospect Care Plan with monthly prices.

Allegation: Staff is not properly assessing residents.
Facility retains residents with unstageable pressure injuries.
The complainant indicates the facility is non-compliant with its practices and is admitting or retaining residents due to low occupancy. The complainant alleges that residents #1-#2 (R1-R2) both residents admitted in July 2020 were not properly assessed during admission and had unstageable pressure injuries. According to medical service records (R1-R2) both completed assessments. (R1) had a Stage 2 pressure injury that was healing and was being assisted by Home Health when she was admitted. According to witness #1 (W1), family member for (R1) only live at this facility for 10 days.

EVALUATION REPORT CONTINUES ON LIC 9099-C

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2021

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20200724100218

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 DR #100
MONTERY PARK, CA 91754

FACILITY NAME: BROOKDALE SANTA MONICA GARDENS	FACILITY NUMBER: 197606682
	VISIT DATE: 10/13/2021

NARRATIVE

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(R1) realized the facility was not the right fit coming from a skilled nursing facility. (R2) was admitted with a Stage 1 wound that was care for by Siena Home Health. According to witness #2 (W2), a family member for (R2) was at this facility for five months. During (R2’s) residency, his wounds never developed to a higher stage. (W1 and W2) described the facility prides itself on customer satisfaction and that the management and staff achieved this with both (R1 and R2) during their short-term residency. Interviews were conducted with residents #4-#11 (R4-R11) all claimed assessments were preformed and that none of them had any pressure wounds. The residents (R4-R11) reported they had no knowledge of any residents are retained with pressure injuries. (R4-R11) asserted the facility maintains a high caliber of well-informed staff to assess the resident's care needs. An interview with witness #3 (W3), family member states (R3) had a minor skin tear on the lower leg and that Home Health had addressed the wound. (R3) was a resident at this facility for 14 years and had nothing but praises for its management and staff. An interview with staff #1-#5 (S1-S5) claimed that all residents must have a Physician’s Report LIC 602A and an assessment with the Health and Wellness Director in order to be a resident at this facility. Furthermore, existing residents undergo either a 6-month or 12-month annual assessment. According to (S1), he disputes the accusation the facility retained residents due to low census. (S1) provided the Department with an Occupancy Trend Report as proof showing occupancy performance based on availability during the entire year of 2020 through 2021 where it showed the trend during COVID-19 phase.

Allegation: Facility retaining residents that require a higher level of care.
The complainant alleges resident #3 and #4 (R3-R4) required a higher level of care and should have been on hospice care. The complainant states (R3-R4) needed to be fed or will not eat and that hospice needed to be involved. According to witness #3 (W3) a family member of (R3), due to COVID-19 and its restrictions, (R3’s) well-being was affected and that a declined in her health condition progressed in July 2020. Medical progress notes revealed that staff assisted (R3) with food intake and that physician’s appointments were in placed and hospice care was recommended by the Brookdale. Records indicate that there was no neglect or lack of supervision with (R3’s) care. The facility involved witness #3 (W3) through the entire process and information were documented. (R3) was eventually placed on hospice according to (W3). An interview with resident #4 (R4) indicated that he did not require assistance with food intake nor was he ever considered for hospice care.

EVALUATION REPORT CONTINUES ON LIC 9099-C

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 11-AS-20200724100218

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 DR #100
MONTERY PARK, CA 91754

FACILITY NAME: BROOKDALE SANTA MONICA GARDENS	FACILITY NUMBER: 197606682
	VISIT DATE: 10/13/2021

NARRATIVE

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Interviews conducted with resident #5-#11 all revealed that have no signs of any residents that require a higher-level care. According to staff #1-#5 (S1-S5) there are no residents that are being retained at this facility that require a higher level of care that would be in violation of Title 22 Regulations 87615 Prohibited Health Conditions. The facility maintains a hospice waiver approved by the Department for 10 residents and continues to implement employee training programs which addresses the nature of these issues.

The Department’s investigation consisted of an inspection of the facility, observation, analysis of (R1-R5) service records, facility documents, and interviews conducted and found no evidence to support the allegations: "Facility charging resident for unneeded services", "Staff is not properly assessing residents", "Facility retains residents with unstageable pressure injuries", "Facility retaining residents that require a higher level of care".

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.

No deficiencies cited during this visit.

An exit interview was conducted with Ralph Balbin and a copy of the report was provided by email.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2021

LIC9099 (FAS) - (06/04)

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