197802426-3-23-2023-28-AS-MVAO-CTPNUJ-20230713104625

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197802426
Report Date: 03/23/2023
Date Signed: 03/23/2023 01:32:10 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
03/17/2023 and conducted by Evaluator Christine Wong

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230317102525

FACILITY NAME:	BROOKDALE ALHAMBRA		FACILITY NUMBER:	197802426
ADMINISTRATOR:	JINA MALEKSARKISSIANS		FACILITY TYPE:	740
ADDRESS:	1 E COMMONWEALTH AVE		TELEPHONE:	(626) 289-3871
CITY:	ALHAMBRA	STATE: CA	ZIP CODE:	91801
CAPACITY:	150	CENSUS: 57	DATE:	03/23/2023
		UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Jina Maleksarkissians		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Staff does not maintain adequet staffing during PM shift

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA)Christine Wong conducted the “Initial 10-Day” visit to ascertain information pertaining to the above-mentioned allegation and to establish the validity of the complaint. LPA met with Business Office Manager Lois Morales Pasquier who allowed entry into the facility and was later met by Administrator Jina Maleksarkissians who assisted with the visit.

The investigation consisted of the following: LPA interviewed administrator and four staff (S1-S4)in the facility and five (5) residents in the facility (R1-R5) and two staff (R6-R7) via telephone and obtained residents and staff roster, staff work shift schedule for March 23, 2023 and resident services summary report

The investigation revealed of the following: Allegation"Staff does not maintain adequate staffing during PM shift. LPA interviewed 5 residents and 5 out of 5 reported the facility does not have an adequate staffing during PM shift. (See LIC 9099C for continuation)

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323)980-4934
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 03/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2023

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-20230317102525

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: BROOKDALE ALHAMBRA	FACILITY NUMBER: 197802426
	VISIT DATE: 03/23/2023

NARRATIVE

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They all said that the facility does not have enough staffing for all shifts, not just PM shift. Some residents also expressed recently they had to wait for over an hour or so while they pressed the pendant for help. Residents stated that they have no complaint to the staff as they are all great and nice, it just the facility has short staffing at the moment. LPA interviewed staff and all reported that the facility is cutting down the staff hours and especially during the PM shift, they are only down to one caregiver and one Med-tech. Med-tech also has to carry out the caregiver duties too. Caregiver reported that Med-tech usually have their own task to be completed including passing the medication and medication related tasks and they only can help when they are not busy. According to the administrator, they hired staff according to each residents services needed. While LPA reviewed the record, LPA observed there are about 8 residents needs full care assistance including showering , medication, grooming, toileting, escorting ..etc.

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: David Sicairos	TELEPHONE: (323)980-4934
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 03/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2023

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20230317102525

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: BROOKDALE ALHAMBRA	FACILITY NUMBER: 197802426
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/23/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/30/2023 Section Cited CCR 87411(a)	1 2 3 4 5 6 7	87411 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. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance	1 2 3 4 5 6 7	Administrator to submit written Plan of Correction to ensure the facility is meeting Title 22 Regulation. Administrator to submit a faxed or mailed copy of POC by due date.
	8 9 10 11 12 13 14	The requirement is not met as evidenced by LPA's interviews with staff and residents which stated that they only have one caregiver and one med-tech during the PM shift and residents expressed staff takes more than an hour to response the pendants which posed a potential risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: David Sicairos	TELEPHONE: (323)980-4934
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 03/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2023

LIC9099 (FAS) - (06/04)

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