198204758-12-4-2024-11-AS-UCOL-DBX2Q3-20241213163513

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198204758
Report Date: 12/04/2024
Date Signed: 12/04/2024 03:13:26 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, 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
10/25/2024 and conducted by Evaluator Regina Cloyd

COMPLAINT CONTROL NUMBER: 11-AS-20241025161602

FACILITY NAME:	BROOKDALE OCEAN HOUSE		FACILITY NUMBER:	198204758
ADMINISTRATOR:	HELEN LEE		FACILITY TYPE:	740
ADDRESS:	2107 OCEAN AVE		TELEPHONE:	(310) 399-3227
CITY:	SANTA MONICA	STATE: CA	ZIP CODE:	90405
CAPACITY:	150	CENSUS: 83	DATE:	12/04/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Helen Lee		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Facility staff did not dispense medications as prescribed.
Facility staff did not respond to resident's call button.

INVESTIGATION FINDINGS:

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The investigation consisted of the following:

On 10/31/2024, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced complaint investigation at the above facility to address the following allegations. LPA conducted resident and staff interviews and reviewed medication, training, and facility records. On 12/04/24, LPA conducted a subsequent complaint investigation and met with Executive Director Helen Lee and explained the purpose of the visit. During today’s investigation, LPA reviewed resident and facility records, reviewed medication, and interviewed staff.

Regarding the allegation "Facility staff did not dispense medications as prescribed," it is being alleged staff gave Resident #1’s medication late or not at all. Specifically, medication #1, #2, and #3 was not given as instructed. Record review revealed medication #1 was administered daily except once in September 2024 and twice in October 2024 due to not being at the facility and hospitalization. Continue to LIC9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024

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-20241025161602

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: BROOKDALE OCEAN HOUSE	FACILITY NUMBER: 198204758
	VISIT DATE: 12/04/2024

NARRATIVE

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Medication #2 was administered daily except for twice in September and eleven times in October due to medication refusal, not being at the facility, and hospitalization. Medication #3 is a pro re nata (PRN) and was administered once in September. Medication #1 and #2 are to be given daily and they were given as prescribed. LPA observed the labeling instructions for medication #1, #2, and #3 and it matches the instruction listed on electronic medication administration record. Plus, the label did not list a specific time but but morning for medication #2. Seven out of ten staff members indicated there hasn’t been any medication complaints in September nor October. One staff member was unable to recall. One staff indicated residents only complain if there are no refills or if the doctor discontinues the medication without them knowing. One staff indicated resident complained when medication did not arrive on time due to the hospital pharmacy. Three out of nine residents indicated staff has not made medication errors. One resident is unaware if errors are made and five residents do not need medication assistance.

Regarding the allegation “Facility staff did not dispense medications as prescribed," based on record reviews, interviews, and observations, the Department found no evidence to support the allegation mentioned above. 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, as a result, the allegation is Unsubstantiated.

No deficiency was cited for this allegation.

Allegation:

Regarding the allegation "Facility staff did not respond to resident's call button," it is being alleged Resident #1 (R1) had three unwitnessed falls and even though R1 pressed R1’s emergency bracelet, R1 remained on the floor for one fall from 1:00 AM to 8:00 AM. Record review revealed R1 made five calls after 10:00 PM that exceeded 10 minutes (in October 2024). The response time ranged from 18 – 32 minutes. Interview with the Administrator (S1) indicated that the call logs do not clear right away because staff clear the calls while leaving. S1 indicated that staff will provide care to the resident first and then clear the call. LPA observed call bracelet with magnetic strip and call system on the monitor at the front desk. Interview with S1 indicated the facility has 24-hour concierge services. Eight out of ten staff interviews indicated staff responds to call buttons within ten minutes or they will radio for assistance. Six staff interviews, including S1, indicated they carry pagers on all shifts. Interview with S1 indicate staff conduct a couple of rounds per shift and will respond to calls within 7 – 15 minutes. Four out of nine resident interviews indicated staff respond within 10 – 30 minutes. Five out of nine resident interviews indicated they have not made calls at night. Continue to LIC9099-C.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20241025161602

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: BROOKDALE OCEAN HOUSE	FACILITY NUMBER: 198204758
	VISIT DATE: 12/04/2024

NARRATIVE

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Regarding the allegation “Facility staff did not respond to resident's call button," based on record reviews, interviews, and observations, the Department found no evidence to support the allegation mentioned above. 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, as a result, the allegation is Unsubstantiated.

No deficiency was cited for this allegation.

An exit interview was conducted and a copy of this report was provided to the Administrator Helen Lee.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 3