197606945-6-3-2021-28-AS-MVAO-C5BRE6-20210727125700

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606945
Report Date: 06/02/2021
Date Signed: 06/03/2021 12:17:09 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:	02:14 PM
MET WITH:	Barbara Tyler, Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Facility is in disrepair.

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 resident bathrooms [rooms: 103, 111, 115, 117, 208, 233, 243, 252, 259], common areas, kitchen/dining room, and basement floor areas. A total of 10 residents and 4 staff interviews were conducted. On 5/26/2021, during an annual inspection visit the main entrance of the facility was temporarily closed due to major plumbing issues on the 1st floor. The Maintenance Director and Administrator were interviewed on 5/26/2021. Resident (R1's) file documents were obtained.

See LIC 9099C for report continuation.

Substantiated

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 is in disrepair." Based on observations and interviews conducted the findings indicate resident (R1) reported to facility staff in November and December 2020 that maintenance repairs such as, bathroom plumbing issues and room fixtures were in disrepair. Seven (7) out of 10 residents interviewed confirmed maintenance issues with plumbing, and disrepair in some resident rooms. Residents reported their toilets have been clogged on/off since the latter part of 2020, and as recent as March 2021. On 5/19/2021, LPA conducted random room inspections and checked toilet flushing and sink water flow to see if there was any clogging issues. The public restroom on the 1st floor was observed to have a clogging issue. In addition, a resident stated that it reported a maintenance problem in its room during early 2021 that still had not been resolved as of 5/19/2021. Room (103) had a broken faucet handle that has been in disrepair for months. Room 115's entrance door was jammed and hard to open and also had a broken toilet seat.

Per staff interviews, the facility experienced sub pump plumbing issues in the basement area on November 5, 2020 that affected one of the laundry areas. An outside plumber was not contacted, and all plumbing issues were handled by maintenance staff. On 5/26/2021, during an annual inspection visit the main entrance of the facility was temporarily closed due to major plumbing issues on the 1st floor. The area is under construction due to water damage, and installation of new plumbing pipes in the facility.

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 was conducted with Administrator Barbara Tyler. A copy of the report an appeal rights were provided.

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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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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/02/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/07/2021 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	87303(a) Maintenance and Operation. 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 requirement was not met by evidence of:	1 2 3 4 5 6 7	Administrator stated that major plumbing issues throughout the building are presently being repaired; which includes hydro jetting of interior/exterior plumbing pipes and full restoration of 1st floor damaged rooms. The repairs are estimated to be completed by July 7, 2021. Administrator agreed to submit proof that all repairs were completed.
	8 9 10 11 12 13 14	Based on observation during random room inspection and interviews conducted facility has had plumbing issues since Fall 2020. In addition 3 rooms [103, 115, 243], and 1st floor public restroom were observed to be in need of repairs. On 5/26/2021, the facility's 1st floor was observed to be under construction due to major plumbing issues.	8 9 10 11 12 13 14
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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 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 appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2021

LIC9099 (FAS) - (06/04)

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