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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197606945
Report Date: 05/02/2023
Date Signed: 05/02/2023 02:38:53 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
04/28/2020 and conducted by Evaluator Jewel Baptiste
COMPLAINT CONTROL NUMBER: 28-AS-20200428075226
FACILITY NAME:BROOKDALE CENTRAL WHITTIERFACILITY NUMBER:
197606945
ADMINISTRATOR:TAMI OJIWANGFACILITY TYPE:
740
ADDRESS:8101 S PAINTER AVETELEPHONE:
(562) 698-0596
CITY:WHITTIERSTATE: CAZIP CODE:
90602
CAPACITY:92CENSUS: 54DATE:
05/02/2023
UNANNOUNCEDTIME BEGAN:
01:08 PM
MET WITH:LVN Denise BartleyTIME COMPLETED:
02:50 PM
ALLEGATION(S):
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9
Staff failed to meet resident's hygiene needs
Staff failed to give resident medication timely
INVESTIGATION FINDINGS:
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13
On 5/02/2023 at 12:00 p.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted a subsequent 10-Day complaint visit to deliver findings on the above-listed allegations. The purpose of the visit was discussed with LVN Denise Bartley .

During the initial visit conducted on 05/5/2020, LPA requested copies of resident and staff rosters, a list of Residents that have moved out from this facility, including their contact information (from September 2019 to April 2020), and a list of Staff that are no longer working at this facility including their contact information (from September 2019 to April 2020).

Report continued on 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel BaptisteTELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2023
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 5
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
04/28/2020 and conducted by Evaluator Jewel Baptiste
COMPLAINT CONTROL NUMBER: 28-AS-20200428075226

FACILITY NAME:BROOKDALE CENTRAL WHITTIERFACILITY NUMBER:
197606945
ADMINISTRATOR:TAMI OJIWANGFACILITY TYPE:
740
ADDRESS:8101 S PAINTER AVETELEPHONE:
(562) 698-0596
CITY:WHITTIERSTATE: CAZIP CODE:
90602
CAPACITY:92CENSUS: 54DATE:
05/02/2023
UNANNOUNCEDTIME BEGAN:
01:08 PM
MET WITH:LVN Denise BartelyTIME COMPLETED:
02:50 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff members spoke inappropriately to resident
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 5/02/2023 at 12:00 p.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted a subsequent 10-Day complaint visit to deliver findings on the above-listed allegations. The purpose of the visit was discussed with LVN Denise Bartely.

During the initial visit conducted on 05/5/2020, LPA requested copies of resident and staff rosters, a list of Residents that have moved out from this facility, including their contact information (from September 2019 to April 2020), and a list of Staff that are no longer working at this facility including their contact information (from September 2019 to April 2020).

Report continued on 9099C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel BaptisteTELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 28-AS-20200428075226
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 CENTRAL WHITTIER
FACILITY NUMBER: 197606945
VISIT DATE: 05/02/2023
NARRATIVE
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During the visit on 3/24/2023, a physical tour of the facility was conducted, LPA interviewed Executive Director Barbara Tyler, Staff (S4-S7), Residents (R2- R7), and a family member (R11). Medications for R2 and R8-R10 were reviewed. File review was conducted for R1, and former Staff members (S1-S3). LPA obtained the staff roster, resident roster, S1 disciplinary actions, and R1’s family member's correspondence with the facility. LPA attempted to contact former staff members (S1-S3) and left a voice mail. LPA interviewed S1 after the visit was completed.

The investigation reveals the following: Regarding “Staff members spoke inappropriately to the resident.” It is alleged that S1 was unprofessional and inappropriate to residents. The interview with the Executive Director confirmed that some residents thought S1 was rude. The Executive Director further stated that S1 may have been stressed due to working a lot of hours during that time. 2 out of 4 staff expressed that S1 and S2 was aggressive with residents. 1 out of 4 Staff stated S1 worked a lot and seemed to be stretched thin. 1 out of 4 staff did not work with S1 but commented that staff does not treat the residents inappropriately. 4 out of 6 residents do not remember S1. 1 out of 6 of residents stated S1 was rough when providing showers. 1 out of 6 residents never met S1 but commented that the staff is friendly. During the interview, S1 denied the allegation. LPA reviewed S1’s file and observed S1 received three (3) corrective actions from the facility for inappropriate acts towards a resident or failing to provide appropriate care to residents. S1’s disciplinary actions led to S1’s termination.

Based on LPA observation, interviews and file review, the preponderance of evidence standard has been met, therefore the above allegations is found to be SUBSTANTIATED. California Code of Regulation, Title 22 are being cited on the attached LIC9099D.

Exit Interview Conducted with Denise Bartley and Christina Schoech / Appeal Rights / A Copy of the report was emailed to the facility
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel BaptisteTELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 28-AS-20200428075226
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 CENTRAL WHITTIER
FACILITY NUMBER: 197606945
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/02/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/26/2023
Section Cited
CCR
87468.1(a)(1)
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87468.1 Personal Rights of Residents in All Facilities.(1) To be accorded dignity in their personal relationships with staff, residents, and other persons.
This requirement was not met by evidence of:
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Administrative Assistant agreed to conduct Personal Rights In-Service training with all staff and review Title 22 Regulations Section 87468.1 Personal Rights. Facility must adhere to Plan of Operation. All traing logs shall be submited to LPA for review by POC due date.
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Based on client and staff interviews, as well as document review, it was confirmed that S1 was rough, aggressive and inappropriate towards. which poses an potential health, safety, or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel BaptisteTELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 28-AS-20200428075226
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 CENTRAL WHITTIER
FACILITY NUMBER: 197606945
VISIT DATE: 05/02/2023
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
During the visit on 3/24/2023, a physical tour of the facility was conducted, LPA interviewed Executive Director Barbara Tyler, Staff (S4-S7), Residents (R2- R7), and a family member (R11). Medications for R2 and R8-R10 were reviewed. File review was conducted for R1, and former Staff members (S1-S3). LPA obtained the staff roster, resident roster, S1 disciplinary actions, and R1’s family member's correspondence with the facility. LPA attempted to contact former staff members (S1-S3) and left a voice mail. LPA interviewed S1 after the visit was completed.

The investigation reveals the following: Regarding “Staff failed to meet the resident’s hygiene needs.” It is alleged that S1 was chastising R1 for frequent diaper changes. The interview with the Executive Director and staff concluded with everyone denying the allegation, stating that they have not received any complaints from residents regarding the issue. They also expressed that the facility has always taken care of the resident’s hygiene needs. 3 out of 6 residents stated that they are independent and do not need assistance. 3 out of 6 residents stated the facility takes care of their hygiene needs.

The investigation reveals the following: Regarding “Staff failed to give resident medication timely.” It is alleged that medications were provided two (2) hours late. The interview with the Executive Director and staff concluded with everyone denying the allegation, stating that the facility administers residents’ medications on time. 2 out of 6 residents expressed that they are independent and do not need assistance with their medications. 1 out of 6 of residents expressed that they do not take medications. 3 out of 6 residents stated the facility has always given them their medications timely.

Based on LPA's interviews, investigation revealed: 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.

Exit interview conducted with Denise Bartley and Christina Schoech and a copy of this record was emailed to the facility.
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel BaptisteTELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5