198204758-6-22-2023-11-AS-MVAO-CXLTWW-20231115140612

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198204758
Report Date: 06/22/2023
Date Signed: 06/22/2023 07:13:15 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/14/2023 and conducted by Evaluator Wendy Gibbs

COMPLAINT CONTROL NUMBER: 11-AS-20230614132722

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: 67	DATE:	06/22/2023
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Matan Burstyn		TIME COMPLETED:	04:59 PM

ALLEGATION(S):

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Licensee does not ensure facility is adequately staffed to meet residents’ needs.

INVESTIGATION FINDINGS:

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On 06/22/23, Licensing Program Analyst (LPA), Wendy Gibbs, initiated a complaint visit at the facility listed above. LPA Gibbs met with Executive Director, Matan Burstyn, and explained the purpose of today's visit.

During today's visit LPA Gibbs toured the physical plant with Executive Director Burstyn. LPA Gibbs reviewed and received resident roster, staff roster, and staffing schedule. LPA Gibbs conducted interviews with Executive Director (S1), Staff (S2-S6), and Residents (R1-R8).
Today's investigation relealed the following:

Allegation: Licensee does not ensure facility is adequately staffed to meet residents’ needs.
During the visit LPA interviewed three (3 )caregivers, and two (2)Med-Tech/Caregivers. Two (2) of the caregivers and one (1) MedTech/Caregiver work the morning shift 6am-2 or 2:30pm. One (1) Caregiver covers floors 2- half of 6 and the other covers half of 6-10. On the evening shift there is one (1) Caregiver and one (1) Med-Tech/Caregiver from 2:00- 10:00pm. The nurse is on 11-8pm.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023

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 11-AS-20230614132722

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: BROOKDALE OCEAN HOUSE	FACILITY NUMBER: 198204758
	VISIT DATE: 06/22/2023

NARRATIVE

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Interviews revealed that each caregiver is assisting 3-4 residents with showers daily, 5-10 residents need assistance dressing and general grooming, helping residents in and out of wheelchairs, 5-10 resident who need assistance while using the restroom or with incontinent care and 5 residents who need escorted to the dining room for meals.

Based on the information provided by the caregivers, each of them is spending at least 2 hrs to provide assistance to Residents using the bathroom (10-15min per person, 4 times per shift), 1.5-2 hours to provide escort assistance to 3-5 residents, (5-10min per resident, 3 times a day to and from meal service). Each caregiver provides 3-4 shower assistance approximately 25-30 minutes. Care givers are assisting 5-7 residents with dressing and general grooming 1.5-2 hours. After assisting residents, with their activities of daily living, some caregivers are taking out the trash, and making beds, which takes at list 40-50min. Based on interviews, observation, review needs and services plan of current population and staff schedule, it was concluded that within 8-hour shift staff is mainly assisting residents requiring help with daily needs, and are not always able to assist other residents when needed.

Overall investigation revealed that additional qualified personnel is needed, to assist overall population with all their activities of daily living. The Executive Director and staff have indicated that staff scheduling have been changed around to add assistance in peak hours.

The information and evidence obtained during this investigation, is sufficient enough to support the allegation. Therefore, the allegation is SUBSTANTIATED at this time. Per California Code of Regulation, Title 22, Division 6, Chapter 8, following citations were issued and recorded on LIC9099D

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20230614132722

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: BROOKDALE OCEAN HOUSE	FACILITY NUMBER: 198204758
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/22/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/30/2023 Section Cited CCR 87411(a)	1 2 3 4 5 6 7	87411(a) Personnel Requirements-General. Personnel shall at all times be sufficient in numbers and competent to provide the services necessary to meet resident needs. This requirement is not met as evidenced by.	1 2 3 4 5 6 7	The Administrator will provide written plan of action explaining what steps they are going to do to retain sufficient number of qualified personnel to assist current population. POC must be completed by POC due date.
	8 9 10 11 12 13 14	Based on interviews, record review Licensee did not insure a sufficient number of competent staff. During 8 hours shift staff cannot assist all residents requiring assistance with daily needs. This possess potential Health & Safety 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: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023

LIC9099 (FAS) - (06/04)

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