197606945-12-7-2023-28-AS-RORN-CYFVX5-20231212154857

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606945
Report Date: 12/07/2023
Date Signed: 12/07/2023 10:59:12 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
12/17/2021 and conducted by Evaluator Christine Wong

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20211217150248

FACILITY NAME:	BROOKDALE CENTRAL WHITTIER		FACILITY NUMBER:	197606945
ADMINISTRATOR:	BARBARA TYLER		FACILITY TYPE:	740
ADDRESS:	8101 S PAINTER AVE		TELEPHONE:	(562) 698-0596
CITY:	WHITTIER	STATE: CA	ZIP CODE:	90602
CAPACITY:	92	CENSUS: 48	DATE:	12/07/2023
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Sanjay Kababi		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Resident sustained a fracture while in care.

INVESTIGATION FINDINGS:

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***This report supersedes the previous complaint report dated 01/13/23. The reason it’s being superseded is to clarify the investigation findings and include additional information. The finding remains the same. ***

Licensing Program Analyst (LPA) Christine Wong conducted a “Subsequent” visit to ascertain additional information regarding the above-mentioned allegation and for the purpose of rendering the finding. LPA met with Receptionist Carlina Gomez who allowed entry into the facility and explained the reason for the visit. The administrator, Barbara Tyler, arrived later and assisted with the visit.

The investigation consisted of the following: On 12/20/2021, LPA conducted a health and safety check. LPA toured the facility with Denise Bartley and observed that the facility is clean and in good repair.

(See LIC 9099C for continuation)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323)980-4934
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023

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 28-AS-20211217150248

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: BROOKDALE CENTRAL WHITTIER	FACILITY NUMBER: 197606945
	VISIT DATE: 12/07/2023

NARRATIVE

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LPA also observed supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days. Restrooms, hand washing basins, toilets and bathtub/showers are operable. There are no immediate health and safety concerns. LPA also gathered information from Resident#1 (R1) file and reviewed two other residents' files. The following documents were collected which included: staff and resident roster, R1's resident information/emergency contact sheet, physician report dated on 10/12/21, preplacement appraisal information, physician/healthcare provider order sheet and care profile. The complaint was referred to the CCL IB investigation Unit and assigned to IB Investigator Garcia for full investigation. IB investigator Garcia conducted and completed the investigation which included interviews with the facility administrator, resident’s relatives, facility residents, six facility staff, resident’s physical therapist. IB Investigator Garcia also obtained Hospital Record, police report and facility progress notes.

The investigation revealed of the following: Regarding the allegation of “Resident sustained a fracture while in care.” It’s alleged that R1 was rough handled by a facility caregiver. After interviews with administrator and the facility staff, based on interviews and statements provided, there is insufficient evidence to determine if facility caregiver caused the fracture to R1’s right rib. Additionally, per the medical records no evidence of suspected abuse or neglect was deemed at the time of the medical evaluation.

Therefore, based on the interviews and statements provided, there’s no sufficient evidence to support the allegation of resident sustained an unexplained fracture while in care. Therefore, LPA finds the allegation to be UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur., therefore the allegation is UNSUBSTANTIATED.

An Exit Interview Conducted and a copy of the report and appeal right was provided to Administrator Sanjay Kabadi

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323)980-4934
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023

LIC9099 (FAS) - (06/04)

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