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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197802426
Report Date: 10/10/2022
Date Signed: 10/10/2022 04:31:31 PM

Substantiated


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
10/04/2022 and conducted by Evaluator Mary G Flores
COMPLAINT CONTROL NUMBER: 28-AS-20221004111051
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: 55DATE:
10/10/2022
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Jina Maleksarkissians - Executive Director TIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Facility staff do not maintain enough food for residents
INVESTIGATION FINDINGS:
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Licensing Program Analyst(s)(LPA) Mary Flores conducted a complaint investigation visit regarding the above allegation(s). LPA met with Jina Maleksarkissians Executive Director and explained the reason for the visit.

The investigation consisted of the following: LPA Flores requested roster for staff/residents. LPA Flores conducted a tour of facility's commercial kitchen and interviewed resident #1(R1),#2(R2),#3(R3),#4(R4),#5(R5), #6(R6) and staff #1(S1),#2(S2),#3(S3),#4(S4),#5(S5). LPA requested list of residents with food restrictions, physician's report, needs and care service plan, and face sheets for R1,R2,R3,R4,R5,R6, resident #7(R7) and #8(R8), and food order invoices for September and October 2022.

The investigation revealed the following: Regarding allegation: Facility staff do not maintain enough food for residents. It is alleged facility bought food but it was not enough for the residents to all eat. Interviews with residents revealed 4 out of 6 residents interview stated there is enough food provided to the residents.(CONTINUED ON LIC 9099C)
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Stefanie CoronelTELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Mary G FloresTELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2022
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 6
Control Number 28-AS-20221004111051
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: 10/10/2022
NARRATIVE
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1 out of 6 residents stated there isn't enough food for the residents, and 1 out of 6 residents refused to be interviewed. Interviews with staff revealed 3 out of 5 staff interviewed stated that there isn't always enough food for the residents. 1 out of 5 staff interview stated there are times when the food runs out and 1 out of 5 staff stated that there is always enough food to serve to the residents. During the tour of the facility's kitchen LPA observed fruits and vegetables, some boxes of either beef or chicken. The pantry was observed to have grains, pastas, and some can foods. LPA observed meal preparation for lunch for about 40 residents on the main dish and 8 rations of the substitute for the day. LPA reviewed facility's invoice orders for the month of September and October 2022, A total of 10 invoices were reviewed. LPA observed than on 10/6/22 facility ordered a total of 6 boxes of meat of either pork or ground beef/beef stew. Facilities menu for the week of 10/9/22 - 10/15/22 list that the residents will be serve lunch or dinner with a variety of meats; such as chicken, pork, meat loaf, shrimp, steak and for each day a substitute of fish. Fish, tuna, chicken tenders were not observed stored per the menu for the week of 10/9 - 10/15/22.

Based on interviews, observation, and documents review conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Tittle 22, Division 6 and Chapter 8 are being cited.

Exit interview was conducted with Jina Maleksarkissians Executive Director and a copy of this report, LIC 9099D, and appeal rights were provided.



SUPERVISOR'S NAME: Stefanie CoronelTELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Mary G FloresTELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 6
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
10/04/2022 and conducted by Evaluator Mary G Flores
COMPLAINT CONTROL NUMBER: 28-AS-20221004111051

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: 55DATE:
10/10/2022
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Jina Maleksarkissians - Executive Director TIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Facility staff are not meeting residents dietary needs
Facility lacks finances to purchase enough food
Facility staff are not following meal menu
INVESTIGATION FINDINGS:
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Licensing Program Analyst(s)(LPA) Mary Flores conducted a complaint investigation visit regarding the above allegation(s). LPA met with Jina Maleksarkissians Executive Director and explained the reason for the visit.

The investigation consisted of the following: LPA Flores requested roster for staff/residents. LPA Flores conducted a tour of facility's commercial kitchen and interviewed resident #1(R1),#2(R2),#3(R3),#4(R4),#5(R5), #6(R6) and staff #1(S1),#2(S2),#3(S3),#4(S4),#5(S5). LPA requested list of residents with food restrictions, physician's report, needs and care service plan, and face sheets for R1,R2,R3,R4,R5,R6, resident #7(R7), and #8(R8) and food order invoices for September and October 2022.

The investigation revealed the following; Facility staff are not meeting residents dietary needs. It is alleged resident was given regular food when diagnosis is diabetic and had to go to the hospital because blood sugar was 700. Interviews with residents revealed 3 out of 6 residents interviewed stated to not have any dietary restrictions. 1 out of 6 residents stated facility ensures dietary needs are met. 1 out of 6 residents stated to take care of dietary needs self, and 1 out of 6 residents refused to be interview. (CONTINUED ON LIC 9099C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Stefanie CoronelTELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Mary G FloresTELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 28-AS-20221004111051
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: 10/10/2022
NARRATIVE
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Interviews with staff revealed 5 out of 5 staff stated facility is following residents dietary needs either by residents' preference or physician's request. LPA observed a chart located in the kitchen with resident's name, picture, and dietary restriction needs. Documents reviewed revealed 3 out of 8 residents documents reviewed have special diet orders by a physician.

Based on interviews, observation, and document review conducted, there was insufficient evidence to prove the allegation(s). 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.

Regarding allegation: Facility lacks finances to purchase enough food. It is alleged facility staff ordered $1800 worth of food however the money was gone and no food had shown up and facility did not have the money to purchase any more food for the residents. Interviews with 4 out of 6 residents revealed facility provides sufficient food to residents in care. 1 out of 6 residents stated the facility does not provide sufficient food and 1 out of 6 residents refused to be interview. Interviews with staff revealed 3 out of 5 staff stated there have been occasions were there is not sufficient food due to either running out, delivery not being timely. 2 out of 5 staff stated there is always sufficient food to provide to the residents. Per administrator there is a designated amount for grocery shopping within the facility's budget that should be sufficient to cover the expenses of groceries. Invoices reviewed revealed facility orders groceries every 3 - 4 days and the amount of groceries is the same, the total amount of expenses for the month of September was under the provided budget.

Based on interviews, observation, and document review conducted, there was insufficient evidence to prove the allegation(s). 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.

Regarding allegation: Facility staff are not following meal menu. It is alleged facility was supposed to feed 60 people with fish but since they ran out only 30 people got fish and the rest got PB&J sandwiches. Interviews with residents revealed 4 out of 6 residents stated facility follows the weekly menu provided. 1 out of 6 residents stated to not know if facility follows menu and 1 out of 6 residents refused to be interview. Interviews with staff revealed 3 out of 5 staff stated the facility follows the weekly menu and 2 out of 5 staff stated sometimes the menu may not be follow or it is not follow when a produce delivery is missed. LPA reviewed facility's menu, during today's visit facility was serving hamburgers with a substitute of fish, which was listed in the menu.
SUPERVISOR'S NAME: Stefanie CoronelTELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Mary G FloresTELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 28-AS-20221004111051
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: 10/10/2022
NARRATIVE
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Based on interviews, observation, and document review conducted, there was insufficient evidence to prove the allegation(s). 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.

Exit interview was conducted with Jina Maleksarkissians Executive Director and a copy of this report was provided.
SUPERVISOR'S NAME: Stefanie CoronelTELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Mary G FloresTELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 28-AS-20221004111051
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: 10/10/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/11/2022
Section Cited
CCR
87555(b)(26)
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87555 General Food Service Requirements:(b) The following food service requirements shall apply: (26) Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises.

This requirement is not met as evidence by:
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Licensee is to ensure a variety of perishables and non-perishables is to be stored at the facility for at least 2 days worth of perishables and 7 days of non-perishables. Facility will order sufficient food supplies per menu for at least 2 days worth of perishables and 7 days of non-perishables and submit invoices and pictures to the department by POC due date 10/11/22.
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Based on observation and document review licensee did not ensure there is sufficient perishables and non-perishables which poses a potential risk to the health, safety, or personal rights to persons 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: Stefanie CoronelTELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Mary G FloresTELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2022
LIC9099 (FAS) - (06/04)
Page: 6 of 6