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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197606945
Report Date: 06/06/2025
Date Signed: 06/06/2025 12:25:25 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
05/30/2025 and conducted by Evaluator Elizabeth Irra
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250530100910
FACILITY NAME:BROOKDALE CENTRAL WHITTIERFACILITY NUMBER:
197606945
ADMINISTRATOR:SANJAY KABADIFACILITY TYPE:
740
ADDRESS:8101 S PAINTER AVETELEPHONE:
(562) 698-0596
CITY:WHITTIERSTATE: CAZIP CODE:
90602
CAPACITY:92CENSUS: 49DATE:
06/06/2025
UNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Valerie Mendez and Logan HarrisonTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Facility staff do not ensure facility showers are clean and orderly.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Elizabeth Irra conducted an initial visit to investigate the above allegation. LPA met with Valerie Mendez (S-1) and discussed the purpose of today’s visit. Logan Harrison (Executive Director) arrived at approximately 9:20 A.M..

During this visit, LPA obtained a copy of the staff and resident rosters, a list of residents that receive showers in the common shower room (second floor), interviewed Staff #1 (S-1) through Staff # 4 (S-4), interviewed Resident #1 (R-1) through Resident #5 (R-5) and conducted a tour of the second floor common area shower room (with Logan Harrison-Executive Director).

Refer to LIC 9099C for the continuation of this report.
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2025
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 3
Control Number 28-AS-20250530100910
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: BROOKDALE CENTRAL WHITTIER
FACILITY NUMBER: 197606945
VISIT DATE: 06/06/2025
NARRATIVE
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Allegation: Facility staff do not ensure facility showers are clean and orderly. It has been alleged that the second floor common shower needs cleaning, has mildew, fans do not work properly and the vanity is too large. Staff interviews revealed that the second floor common shower is cleaned after every shower provided and that mildew has not been observed. Interviewed staff indicated that residents enjoy the new sink as it has a vanity which provides more space for residents to store their toiletries while using the shower room. (1) out of (4) staff interviews revealed that the fan inside the shower is non-operational. Resident interviews revealed that there are no issues with the second floor common shower other than needing a deep cleaning on the tile grout. LPA also conducted a tour of the second floor common shower. During this tour, LPA observed a new sink with cabinet storage (below the sink). LPA observed the fan above of the sink to be operational, however, it had lint on the lid. LPA observed the tile in the shower needing a deep cleaning (half bottom of shower grout is darker). LPA observed the fan inside the shower to be non-operational. Interviews and tour conducted corroborates this allegation.

Based on observation and interviews conducted the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Deficiency is being cited according to California Code of Regulations, Title 22, Division 6, Chapter 8, Article 05.

An exit interview conducted, copy of this report and appeal rights was provided to Logan Harrison.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20250530100910
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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: 06/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/13/2025
Section Cited
CCR
87303(a)
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Maintenance and Operation (a)The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This standard is not met as evidence by:
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Administrator to provide proof of the shower fan repairs and cleaning, the cleaning of the shower tile grout and a written statement as to how this facility will remain in compliance with this regulation to LPA Irra by POC due date.
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LPA conducted a tour of the second floor common bathroom and observed the fan above the sink had lint on the lid, the fan inside the shower was non-operational and the tile in the shower needs a deep cleaning (half bottom of shower grout is darker).
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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.
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3