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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197802426
Report Date: 04/28/2022
Date Signed: 05/14/2022 04:16:04 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
09/29/2020 and conducted by Evaluator Nicol Wesley
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20200929163144
FACILITY NAME:BROOKDALE ALHAMBRAFACILITY NUMBER:
197802426
ADMINISTRATOR:WENTWORTH, NICOLE DFACILITY TYPE:
740
ADDRESS:1 E COMMONWEALTH AVETELEPHONE:
(626) 289-3871
CITY:ALHAMBRASTATE: CAZIP CODE:
91801
CAPACITY:150CENSUS: 80DATE:
04/28/2022
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Alison PastoresTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Facility has inadequate staffing to meet the needs of the resdients.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Nicol Wesley initiated a subsequent complaint investigation for the allegations listed above and met with Acting Executive Director Alison Pastores to discuss the purpose for todays visit.

The investigation consisted of the following: On 10/08/2020 LPA Wesley conducted a telephonic interview and requested a copy of: staff roster, resident roster, and personnel summary(LIC 500) to be faxed/emailed by 10/09/20. LPA also interviewed the Executive Director and residents regarding the above mentioned allegations.

Regarding allegation: Facility has inadequate staffing to meet the needs of the residents. During the investigation and records review, LPA Wesley could not retrieve or locate any documents that indicated
Continued on LIC 9099C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Nicol WesleyTELEPHONE: (323) 981-3975
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2022
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 5
Control Number 28-AS-20200929163144
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 ALHAMBRA
FACILITY NUMBER: 197802426
VISIT DATE: 04/28/2022
NARRATIVE
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Resident #1(R1) had a fall and there was no information provided as to what date, and what time the fall occurred. LPA Wesley made repeated attempts to interview other parties but was not successful. During the interviews with residents, they advised that they do not have any problems with staff during the late night hours because they are asleep, Interviews with residents also confirmed that the staff conducts room checks at night to make sure their okay and not in need of help or incontinence care and do they do not have problems with staffing at night. During the interview with Administrator Tracey Holder she advised that there are 2 Noc shift staff and 3 caregivers in the facility during the late night hours as the residents do not require direct care and supervision while they are sleeping. Administrator said the night staff conducts room checks and make sure their incontinence residents remain dry and comfortable during the night. Interviews with staff revealed that they do not have a shortage of staff and they are provided assistance and back up while caring for the clients in care. Staff also said they do not need a lot of staff working at night because the residents are sleeping and staff only provides incontinence care to the residents who may need changing during the night, which are very few residents.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur. Therefore the allegation is UNSUBSTANTIATED.

There are no deficiencies cited

Exit interview conducted.
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Nicol WesleyTELEPHONE: (323) 981-3975
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5
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
09/29/2020 and conducted by Evaluator Nicol Wesley
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20200929163144

FACILITY NAME:BROOKDALE ALHAMBRAFACILITY NUMBER:
197802426
ADMINISTRATOR:WENTWORTH, NICOLE DFACILITY TYPE:
740
ADDRESS:1 E COMMONWEALTH AVETELEPHONE:
(626) 289-3871
CITY:ALHAMBRASTATE: CAZIP CODE:
91801
CAPACITY:150CENSUS: 80DATE:
04/28/2022
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Alison PastoresTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Staff do not respond to call light in a timely manner.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Nicol Wesley initiated a subsequent complaint investigation for the allegations listed above and met with Acting Executive Director Alison Pastores to discuss the purpose for todays visit.


The investigation consisted of the following: On 10/08/2020 LPA Wesley conducted a telephonic interview and requested a copy of: staff roster, resident roster, and personnel summary(LIC 500) to be faxed/emailed by 10/09/20. LPA also interviewed the Executive Director and residents regarding the above mentioned allegations.

Regarding allegation: Staff do not respond to call light in a timely manner. During the investigation, Resident #1(R1) informed their family that they had fallen and pressed the call light for assistance and staff took a very long
Continued on LIC 9099C.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Nicol WesleyTELEPHONE: (323) 981-3975
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 28-AS-20200929163144
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 ALHAMBRA
FACILITY NUMBER: 197802426
VISIT DATE: 04/28/2022
NARRATIVE
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time to provide them assistance. During the interview with Administrator Tracey Holder and facility staff they advised that staff would typically respond to resident’s call pendant between 7-10 minutes. Staff said they respond as soon as they receive an alert. The Administrator said when the resident presses the pendant for assistance, a message is sent to all caregivers and it also notifies them the particular residents who is requiring assistance. When the caregiver assist the resident the pendant is reset. During the interviews with residents it was reported that staff can sometimes take up to 30 minutes to respond to them. Although Staff reported that they usually respond right away, the interviews with the residents the majority of them indicated that staff takes between 15 minutes to 30 minutes to respond.

Based on the interviews conducted, the preponderance of evidence standard has been met, therefore, the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 and Chapter 8, are being cited on the attached LIC 9099D.



An exit interview was conducted and a copy of this report was given along with the appeal rights.
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Nicol WesleyTELEPHONE: (323) 981-3975
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 28-AS-20200929163144
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 ALHAMBRA
FACILITY NUMBER: 197802426
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/28/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/12/2022
Section Cited
CCR
87411(a)
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Personnel Requirements -General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs....for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance...
This requirement is not met as evidenced by:
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The Administrator will provide an inservice training to all staff on Personnel Requirements and ensure that all staff are adhering to the residents call light request. Provide the in service sign in sheet with staff signatures and topics discussed by POC due date 05/12/22.
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IDuring the interviews with residents in care, it has been revealed that staff are not responding to the call light assistance within a reasonable timeframe which poses a potential health and safety risk to residents in care.
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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 HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Nicol WesleyTELEPHONE: (323) 981-3975
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 5