197606945-2-27-2024-28-AS-LHIS-D2XMQQ-20240301084904

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606945
Report Date: 02/27/2024
Date Signed: 02/27/2024 01:58:54 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
02/21/2024 and conducted by Evaluator Noemi Galarza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240221091238

FACILITY NAME:	BROOKDALE CENTRAL WHITTIER		FACILITY NUMBER:	197606945
ADMINISTRATOR:	SANJAY KABADI		FACILITY TYPE:	740
ADDRESS:	8101 S PAINTER AVE		TELEPHONE:	(562) 698-0596
CITY:	WHITTIER	STATE: CA	ZIP CODE:	90602
CAPACITY:	92	CENSUS: 50	DATE:	02/27/2024
		UNANNOUNCED	TIME BEGAN:	09:01 AM
MET WITH:	Sanjay Kabadi, Executive Director		TIME COMPLETED:	02:05 PM

ALLEGATION(S):

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Staff placed a resident on hospice against their wishes.
Staff are not following a resident's legal documentation.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Galarza conducted an initial 10-day complaint investigation visit in regards to the allegation listed above. LPA discussed the purpose of the visit with Executive Director Sanjay Kabadi.

The investigation consisted of: A physical plant tour of facility common areas, record review, and interviews of staff (S1- S4), hospice residents (R1-R2). An interview with Power of Attorney (POA) was attempted, but only (F1) was interviewed. The following documents were reviewed/obtained: Resident (R1's) file documents were reviewed. The following documents were obtained: Identification and Emergency Information/Face Sheet, Admission Record, Preplacement Appraisal Information, Personal Service Plan, Physician's Reports, Advance Health Care Directive, Physician's Certification of Incapacity to Make Informed Decision (10/26/23),POLST (8/18/23 & 2/18/24), Home Health Notes, Hospice Admit Notes initiated 2/19/24, incident reports, MARs, LIC 500 Personnel Report, and resident roster.

***See narrative summary on next page.***

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi Galarza	TELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024

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-20240221091238

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: 02/27/2024

NARRATIVE

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Allegation: Staff placed a resident on hospice against their wishes. According to information obtained, resident (R1) was "fraudulently" placed in hospice care and had fluids removed against their will. It is alleged that R1 had a recent stroke, but was still able to communicate with hand gestures i.e., hand squeezes and in writing, but no one asked the resident what they wanted. Resident (R1's) advocates asked the facility to restore fluids but the request was not addressed. Per record review, R1 was sent out to the hospital on February 2, 2024 for a urinary tract infection (UTI). The resident was then transferred to a skilled nursing facility, where R1 had another stroke. A total of four (4) staff were interviewed, of which all stated that R1 has a Power of Attorney (POA), who made the decision to enroll the resident in hospice care while the resident was at a higher level of care facility, and prior to returning to the facility on February 19, 2024. Resident (R1) was enrolled in hospice care the same day he returned to the facility. The resident's diet was "NPO", nothing by mouth, "mouth moistening swabs only". The facility presently has 2 other residents enrolled in hospice and both had cognitive impairment and were unable to respond to the questions. Based on record review of the most recent Physician's Report dated 2/19/24, the MD noted hospice care was needed due to permanent CVA and dysphagia. In addition, R1 has an Advance Health Care Directive effective 1/17/2009, appointing their Power of Attorney (POA), "Not to prolong life" and a POLST dated 8/18/2023, that states "no artificial means of nutrition, including feeding tubes". A 2nd POLST was updated on 2/18/24 by POA and signed by MD on 2/21/2024, to "Comfort-Focused Treatment". Therefore, the findings indicate that the POA placed R1 in hospice care. Therefore, the facility followed the POLST, Advance Directive, and POA's decision to initiate hospice service. NOTE: The facility received a phone call from hospice agency reporting that R1 passed away today.

Allegation: Staff are not following a resident's legal documentation. It is alleged that the facility is violating the resident's rights by following resident (R1's) family member's decisions without having Power of Attorney. Based on record review, the resident moved in on 11/30/2023 and an a copy of an Advance Healthcare Directive dated 1/17/2009 was provided, along with a POLST signed by R1's legally recognized decision maker. All staff interviewed denied the allegation and stated that the facility obtained legal documents appointing R1's sister as the Power of Attorney for healthcare decisions. The findings indicate, there is no merit to the allegation, because R1's file has all legal documents pertaining to healthcare decisions, and the facility is adhering to the stipulations noted on the documents.

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.

Exit interview conducted with Executive Director Sanjay Kabadi. A copy of the report was issued.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi Galarza	TELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024

LIC9099 (FAS) - (06/04)

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