197606945-6-3-2021-28-AS-MVAO-C5BRE7-20210727125701

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606945
Report Date: 06/02/2021
Date Signed: 06/03/2021 12:16:07 PM

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
01/07/2021 and conducted by Evaluator Noemi Galarza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20210107160350

FACILITY NAME:	BROOKDALE CENTRAL WHITTIER		FACILITY NUMBER:	197606945
ADMINISTRATOR:	STEVEN SCIURBA		FACILITY TYPE:	740
ADDRESS:	8101 S PAINTER AVE		TELEPHONE:	(562) 698-0596
CITY:	WHITTIER	STATE: CA	ZIP CODE:	90602
CAPACITY:	92	CENSUS: 73	DATE:	06/02/2021
		UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Barbara Tyler, Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Facility does not provide residents with an adequate quantity of food.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Galarza conducted a subsequent complaint visit to deliver findings on the above allegation. The purpose of the visit was discussed with Administrator Barbara Tyler.

The investigation consisted of the following: On 1/15/2021 a virtual physical plant tour of the common laundry room and resident room 252 was conducted via FaceTime at 4:30 pm. On 5/19/2021 at 11:40 am, LPA conducted an in-person physical plant tour of kitchen, dining room, common areas, resident bathrooms [rooms: 103, 111, 115, 117, 208, 233, 243, 252, 259] and basement floor areas. A total of 10 residents and 4 staff were interviewed. On 5/19/2021 lunch dining service was observed. Food plating and portions were observed prior to meal service. The meal portions are measured per Broodkale Menu Manager guidelines. The lunch menu servings had sufficient quantities of food. Resident (R1's) file documents were obtained, and a copy of Dietician Credential Verification, as well as dining services incident notes pertaining to resident (R1).

See LIC 9099C

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: 06/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2021

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-20210107160350

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: 06/02/2021

NARRATIVE

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Allegation: "Facility does not provide residents with an adequate quantity of food". Based on observations and interviews conducted the findings indicate the facility provides approved measured servings of food during all meal times. Serving size is measured per Brookdale Menu Manager guidelines. If requested residents receive 2nd servings, and can order from an alternative food menu. Six (6) out of 10 residents stated the quantity of food served is sufficient. All residents stated they receive extra food if they ask and can order from an alternative food menu. Kitchen staff stated resident (R1) complained about food issues, and/or alternative food items that were not written down when requesting meals in advance from the alternate food menu. Residents are provided a "Room Service - Pre Order Sheet" they can fill out and request other food items of their choice. Residents are served the items listed on the sheet. Per staff interviews, facility cooks follow approved measured portion guidelines. NOTE: This allegation was received during the COVID-19 pandemic. State guidance recommended no communal dining. Therefore, residents were provided room service meal delivery in containers. There is insufficient evidence to prove the allegation.

Based upon observations and interviews conducted the findings indicate that, 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.

An exit interview was conducted with Administrator Barbara Tyler. 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: 06/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2021

LIC9099 (FAS) - (06/04)

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