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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198204758
Report Date: 11/02/2023
Date Signed: 11/02/2023 12:01:41 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/05/2023 and conducted by Evaluator Lourdes Montoya
COMPLAINT CONTROL NUMBER: 11-AS-20230905082714
FACILITY NAME:BROOKDALE OCEAN HOUSEFACILITY NUMBER:
198204758
ADMINISTRATOR:PARK, THOMASFACILITY TYPE:
740
ADDRESS:2107 OCEAN AVETELEPHONE:
(310) 399-3227
CITY:SANTA MONICASTATE: CAZIP CODE:
90405
CAPACITY:150CENSUS: 73DATE:
11/02/2023
UNANNOUNCEDTIME BEGAN:
10:56 AM
MET WITH:Helen LeeTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Staff do not provide resident with fluids when requested.
Staff do not ensure resident is provided privacy.
Staff do not treat resident with dignity and respect.
INVESTIGATION FINDINGS:
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On 11/2/2023 at 10:56 AM, Licensing Program Analyst (LPA) Lourdes Montoya conducted a subsequent complaint visit to deliver complaint findings of the allegations listed above. LPA Montoya met with Helen Lee, the new Executive Director/Administrator, and explained the purpose of this visit.

The investigations consisted of the following: On 9/12/2023, LPA conducted a tour of the facility. LPA Montoya interviewed 8 out of 76 residents and 7 out of 66 staff. LPA requested and obtained copies of Staff roster, Resident roster, and R1’s service records (Admission Agreement, Physician's Reports, Appraisals/Needs and Services Plans, and other pertinent records associated with this complaint.


REPORT CONTINUED IN LIC 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Lourdes MontoyaTELEPHONE: (510) 725-7918
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023
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 3
Control Number 11-AS-20230905082714
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: BROOKDALE OCEAN HOUSE
FACILITY NUMBER: 198204758
VISIT DATE: 11/02/2023
NARRATIVE
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INVESTIGATIONS REVEALED THE FOLLOWING:

Allegation: Staff do not provide resident with fluids when requested.

According to SOC 341, it was reported that staff declines to give R1 fluids/drinks.

Based on interviews conducted with seven out of eight residents (R2-R8), it was denied that staff do not provide residents with fluids/drinks when requested. Two residents (R7 & R8) revealed they get anything they request from staff. The department was not able to conduct an interview with R1 because R1 has passed away and was no longer available at the time of the visit.

Based on interviews conducted with seven out of seven staff (S1-S7), it was denied that staff do not provide residents with fluids/drinks when requested. Four staff (S1-S4) stated R1 has a reserve of water jug in the bedroom that staff refills it when empty; Staff assists R1 with drinking because R1 has difficulty in drinking and R1 drinks from a cup with a straw. S5 stated when residents ask for water or any other drinks, S5 would get it for them. S6 stated when residents have any concerns, staff or residents would report to S6 and S6 denied that there was any complaint about staff not providing residents with fluids when requested. S7 stated residents would call the front desk for services like requesting fluids but sometimes S7 would bring residents water or juice when requested directly from S7.

Based on LPA's observations during the visit on 9/12/2023, care providers, dining crew and front desk staff are attentive to resident's requests.

Allegation: Staff do not ensure resident is provided privacy.

According to SOC 341, staff have exposed R1’s private areas while taking R1 to the restroom with other people at the present location.

Based on interviews conducted with seven out of eight residents (R2-R8), it was denied that staff do not ensure residents are provided privacy. The department was not able to conduct an interview with R1 because R1 has passed away and was no longer available at the time of the visit.

Based on interviews conducted with seven out of seven staff (S1-S7), It was denied that staff do not ensure resident is provided privacy. Four staff (S1-S4) stated R1 has a private bathroom in the bedroom and R1 did not like using the common bathrooms. S6 stated when residents have any concerns, staff or residents would report to S6 and S6 denied that there was any complaint about staff not ensuring resident is provided privacy.

Based on LPA's observations during the visit on 9/12/2023, LPA did not observe any incidents that violate residents' privacy. LPA observed each resident's bedroom including R1's bedroom has ensuite bathroom.

SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Lourdes MontoyaTELEPHONE: (510) 725-7918
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20230905082714
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: BROOKDALE OCEAN HOUSE
FACILITY NUMBER: 198204758
VISIT DATE: 11/02/2023
NARRATIVE
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This page was amended to change the word "privacy" to dignity/respect on line #16.

Allegation: Staff do not treat resident with dignity and respect.

According to SOC 341, R1 is enduring abuse from a perpetrator consistently.

Based on interviews conducted with seven out of eight residents (R2-R8), it was denied that staff do not treat resident with dignity and respect. Three residents (R2, R7 & R8) revealed staff are respectful. The department was not able to conduct an interview with R1 because R1 has passed away and was no longer available at the time of the visit.

Based on interviews conducted with seven out of seven staff (S1-S7), It was denied that staff do not treat residents with dignity and respect. Two staff (S1-S2) stated staff respect the residents and their families. S3 stated S3 did not have any issue with R1. S4 stated one staff (S8) reported to S4 that one staff (S8) heard S9 telling R1 to stop whining. S4 investigated the issue, R1 and S9 denied the allegation. S4 stated no further investigation was made because there was not enough evidence to prove the allegation. S4 admitted S4 did not report the incident to the facility administrator. LPA made an attempt to interview S8 but S8 was not working at the time of visit. LPA was not able to interview S9 because S9 was no longer working at the facility. S6 stated when residents have any concerns, staff or residents would report to S6 and S6 denied that there was any complaint about staff not ensuring resident is provided dignity/respect.

Based on LPA's observations during the visit on 9/12/2023, staff treat residents with respect.

Based on interviews, available evidence, observations, information received, and records reviewed there was not sufficient evidence to support the allegations, "Staff do not provide resident with fluids when requested, Staff do not ensure resident is provided privacy, Staff do not treat resident with dignity and respect".



Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are deemed UNSUBSTANTIATED. There were no deficiencies cited.

An exit interview was conducted and a hard copy of the report was provided to Helen Lee.
SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Lourdes MontoyaTELEPHONE: (510) 725-7918
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3