197802426-8-18-2022-28-AS-RORN-CJWP2V-20221005105631

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197802426
Report Date: 08/18/2022
Date Signed: 08/18/2022 01:22:11 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
08/10/2022 and conducted by Evaluator Cynthia D Chan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220810165403

FACILITY NAME:	BROOKDALE ALHAMBRA		FACILITY NUMBER:	197802426
ADMINISTRATOR:	WENTWORTH, NICOLE D		FACILITY TYPE:	740
ADDRESS:	1 E COMMONWEALTH AVE		TELEPHONE:	(626) 289-3871
CITY:	ALHAMBRA	STATE: CA	ZIP CODE:	91801
CAPACITY:	150	CENSUS: 58	DATE:	08/18/2022
		UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Jina Maleksarkissians, Executive Director		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Facility has pests.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation for the allegation listed above. LPA met with Sugiarto, the Health & Wellness Director, to explain the purpose of the visit. The Executive Director arrived shortly thereafter to assist.

The investigation consisted of the following:
LPA toured the facility, obtained copies of the staff and resident rosters, and the pest control service report. LPA also interviewed the Executive Director, 5 Staff, and 6 Residents.

The investigation revealed the following:
Regarding allegation - Facility has pests. It is alleged that the facility's kitchen and dining room are infested with flies. The Executive Director stated that she saw some fruit flies around the facility roughly 10 days ago. When she saw them, she immediately requested the Ecolab Pest Control company to service the facility.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022

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-20220810165403

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: 08/18/2022

NARRATIVE

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She stated that a resident approached her to inform about the flies after she had requested for services from the pest control company. Based on the pest control service report, they came out to service for rodents, large flies, and cockroaches on 8/11/22. There were no pests found during their visit. Staff interviewed stated they have seen some flies and gnats but not an infestation of them. They also said that the pest control company came out last week to spray the facility and have not seen anymore as of this week. 2 out of 6 residents reported they have seen lots of flies in the dining room, and one stated after the pest control company came out last week, there are less of them. LPA toured the facility today including the common areas, dining room, kitchen and did not observe any flies. Based on documentation and interviews, the facility had taken measures to control the pest concerns.

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 the Executive Director. A copy of this report along with the appeal rights were provided.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022

LIC9099 (FAS) - (06/04)

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