198204758-5-7-2021-11-AS-EMAZ-C43SSL-20210617140806

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198204758
Report Date: 05/07/2021
Date Signed: 05/07/2021 04:52:57 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 DR #100
MONTERY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/07/2021 and conducted by Evaluator Stephanie Cifuentes

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20210407161224

FACILITY NAME:	BROOKDALE OCEAN HOUSE		FACILITY NUMBER:	198204758
ADMINISTRATOR:	PARK, THOMAS		FACILITY TYPE:	740
ADDRESS:	2107 OCEAN AVE		TELEPHONE:	(310) 399-3227
CITY:	SANTA MONICA	STATE: CA	ZIP CODE:	90405
CAPACITY:	150	CENSUS: 79	DATE:	05/07/2021
		UNANNOUNCED	TIME BEGAN:	03:14 PM
MET WITH:	Tom Rekowski		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Facility has insufficient staffing to meet the residents’ needs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Stephanie Cifuentes initiated a complaint investigation for the allegations listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19) and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Tom Rekowski, Executive Director. LPA explained the purpose of this telephonic visit is to deliver findings

The investigation consisted of the following:

On 4/14/2021 LPA Cifuentes conducted a tour of facility grounds. Tour consisted of lounge area, kitchen, dining room, front lobby, several resident rooms and bathrooms. LPA also interviewed Executive Director Tom Rekowski. On 5/6/2021 LPA interviewed staff 1-staff 6 as well as resident 1-resident 8. LPA requested and received the following documents: staff and client rosters, staff schedule, staff training dates and summary of training.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2021

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 11-AS-20210407161224

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 DR #100
MONTERY PARK, CA 91754

FACILITY NAME: BROOKDALE OCEAN HOUSE	FACILITY NUMBER: 198204758
	VISIT DATE: 05/07/2021

NARRATIVE

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Regarding the allegation: Facility has insufficient staffing to meet the resident’s needs.

The investigation revealed the following:

On 4/14/2021 LPA Cifuentes spoke with Executive Director Tom Rekowski. Mr. Rekowski told LPA that facility staffing was based on residents needs and the number of residents currently living at the facility. Per Mr. Rekowski, the facility is at 68% capacity and most of the residents currently in care are independent, so there are not as many staff required to assist residents. Based on the number of resident and their needs, Mr. Rekowski felt that at this time there are sufficient staff. He also stated that as more residents entered the facility the staffing complement would be expanded.

5/7/2021 LPA Cifuentes reviewed records received from facility. Staff schedules for April and May show three to four caregivers on duty for the morning shift, depending on the day, two for the PM shift, and 1 caregiver for overnight. Each shift also had an assigned medical technician.

On 5/6/2021 LPA Cifuentes interviewed resident 1-resident 8. LPA asked residents if they believed there was sufficient staffing at the facility to meet their needs. 6 out of the 8 residents interviewed stated there was enough staff at the facility to meet their needs.

On 5/6/2021 LPA Cifuentes interviewed staff 1-6. When asked if they believed there were enough staff, 5 of the 6 staff members stated they believed there was enough staff for the amount of residents the facility currently has.

Based on LPA’s observation, interviews conducted, and records reviewed, the preponderance of evidence standard has not been met. 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.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2021

LIC9099 (FAS) - (06/04)

Page: 2 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 DR #100
MONTERY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/07/2021 and conducted by Evaluator Stephanie Cifuentes

COMPLAINT CONTROL NUMBER: 11-AS-20210407161224

FACILITY NAME:	BROOKDALE OCEAN HOUSE		FACILITY NUMBER:	198204758
ADMINISTRATOR:	PARK, THOMAS		FACILITY TYPE:	740
ADDRESS:	2107 OCEAN AVE		TELEPHONE:	(310) 399-3227
CITY:	SANTA MONICA	STATE: CA	ZIP CODE:	90405
CAPACITY:	150	CENSUS: 79	DATE:	05/07/2021
		UNANNOUNCED	TIME BEGAN:	03:14 PM
MET WITH:			TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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9

Untrained Staff

INVESTIGATION FINDINGS:

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Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2021

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 5

Control Number 11-AS-20210407161224

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 DR #100
MONTERY PARK, CA 91754

FACILITY NAME: BROOKDALE OCEAN HOUSE	FACILITY NUMBER: 198204758
	VISIT DATE: 05/07/2021

NARRATIVE

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Regarding the allegation: Untrained staff

The investigation revealed the following:

On 4/14/2021 LPA Cifuentes spoke with Executive Director Tom Rekowski. Mr. Rekowski told LPA that there had been a recent investigation at the facility and that it had been found that some of the staff had been scheduled for tasks they were not properly trained for. It was also found that some of the staff who were supposed to be doing on the job training under an experienced staff were competing tasks alone. When the investigation concluded, a series of training's was immediately scheduled by Mr. Rekowski to ensure the staff had the proper training.

On 5/7/2021 LPA reviewed records received from facility. LPA received sign in sheets showing that 7 staff had received medication technician training. Some of those were caregivers who requested the training. LPA also received a breakdown of the training that staff received during the training.

On 5/6/2021 LPA Cifuentes interviewed resident 1 -resident 8. LPA asked residents if they believed staff had enough training. 4 out of the 8 residents interviewed stated they believed staff needed more training.

On 5/6/2021 LPA Cifuentes interviewed staff 1-6. When LPA asked staff if they believed they had enough training , 5 out of 6 staff stated they believed both they and their coworkers had received enough training.

Based on LPA’s observation, interviews conducted, and records reviewed, the preponderance of evidence standard has been met. Therefore, the above allegation is found to be substantiated. California Code of Regulations, Title 22, Division (6) and chapter (8) are being cited on the attached LIC 9099D.

A telephonic exit interview was conducted with Executive director Tom Rekowski and a hard copy was provided via email for signature.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2021

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 11-AS-20210407161224

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 DR #100
MONTERY PARK, CA 91754

FACILITY NAME: BROOKDALE OCEAN HOUSE	FACILITY NUMBER: 198204758
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/07/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/14/2021 Section Cited CCR 87411(d)	1 2 3 4 5 6 7	All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall provide knowledge of and skill in the following, as appropriate for the job assigned and as evidenced by safe and effective job performance... This requirement was not met as evidenced by:	1 2 3 4 5 6 7	This citation was cleared during LPA's visit on 5/7/2021 by facility providing proof of training sign in sheet and training materials summary.
	8 9 10 11 12 13 14	Based on client and staff interviews as well as records review, the facility failed to ensure staff had sufficient training. This posses a potential health and safety risk to clients 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: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2021

LIC9099 (FAS) - (06/04)

Page: 5 of 5