198204758-1-17-2024-11-AS-UCOL-D3RU8Q-20240327152153

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198204758
Report Date: 01/10/2024
Date Signed: 01/17/2024 10:17:59 AM

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
01/03/2024 and conducted by Evaluator David Espana

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20240103084316

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: 75	DATE:	01/10/2024
		UNANNOUNCED	TIME BEGAN:	09:29 AM
MET WITH:	Helen Lee, Administrator		TIME COMPLETED:	06:00 PM

ALLEGATION(S):

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Licensee does not keep facility elevators maintained in operating condition
Staff do not respond to residents' call buttons in timely manner
Staff does not provide resident with timely meals

INVESTIGATION FINDINGS:

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**This report’s purpose is to provide an amendment to the complaint report created 01/10/2024. This addendum is written to clarify the 9099 and does not change the complaint investigation report findings recorded on 01/10/2024. ** On 01/10/2024 at 9:29 am Licensing Program Analyst (LPA) David España conducted an initiated a 10-day complaint investigation visit for the allegation listed above. Upon arriving at the facility, LPA met with S#1 who assisted with the visit. The purpose of today’s visit was discussed. Upon arrival at the facility, LPA conducted a risk assessment at the front door. Based on the assessment, the facility is not clear of Covid-19 infection (four (4) residents and one (1) staff member have COVID). LPA was granted access and allowed to enter the facility to conduct inspections.The investigation consisted of the following: On 01/10/2024 at 9:29 am LPA España conducted a tour of facility plant; reviewed records for staff and residents and observations. LPA España conducted interviews with Eight (8) out of seventy-five (75) residents. LPA España interviewed Seven (7) out of forty-seven (47) staff members. Continued 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David Espana	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2024

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 4

Control Number 11-AS-20240103084316

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: 01/10/2024

NARRATIVE

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LPA confirmed with the Administrator that there are a total of residents with oxygen one (1); Total residents with dementia one (1); Total residents with wheelchairs nine (9); and Total residents with diapers two (2). LPA requested and reviewed the following: Nurse Call/E-Call Systems: In-house Testing of Nurse Call Systems Last 12 Months; Dining Services Ocean House; Ocean House Schedule; Daily recipes; Nutrition Tracker as of January 9^th; Benefits of Modernization include: Increased durability and reliability; Improved fire and life safety features; Decreased waiting times; Reduced energy consumption; Reduced operational cost; and Reduced troubleshooting time records etc.

Allegation: Licensee does not keep facility elevators maintained in operating condition.
This investigation revealed that interviews conducted with Eight (8) out of seventy-five (75) residents understood the facility was addressing the elevator per town hall once (3^rd Thursday of every month) a monthly resident council meeting (every other week). Interviews conducted with Seven (7) out of forty-seven (47) staff members corroborated that they are addressing the elevators based on corporate investment. Additionally, per town hall once (3^rd Thursday of every month) a month and resident council meeting(every other week) confirms that the Administrator has taken action.
LPA reviewed the following records: Brookdale purchase order elevator po number 3692068.
Based on interview with S#3 as of March 16, 2023, Modernization Proposal TK Elevator Corporation (hereinafter "TK Elevator") is dedicated to delivering (hereinafter "Purchaser") the safest, highest quality vertical transportation solutions Proposal (the "Proposal") in the amount of $592,580 inclusive of all applicable sales and use taxes to modernize the elevator equipment described in the pages provided at todays visit. Additionally, per S#1 the facility is developing the Benefits of Modernization which includes: • Increased durability and reliability • Improved fire and life safety features • Decreased waiting times • Reduced energy consumption • Reduced operational cost • Reduced troubleshooting time. LPA also noted the weekly status report for week ending - 12/15/2023 location - ocean house project commencement 1st elevator inspection 10/9/2023 actual dates 11/27/2023- elevator scope-passed 12/7/2023- fire service scope-passed accomplished. The facility addressed the final adjustments, the facility released elevator no. 1 to service on Monday 12/11 the facility transferred the operation of the hall buttons between elevator no. 1 & 2. the facility began the modernization scope on elevator no. 2. requisition #3768975 (partially received) ocean house elevator modification upgrade work orders for 00967 Brookdale Ocean house logbook report 00967 Brookdale ocean house - Santa Monica, ca 90405-2299.Continued 9099-C

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David Espana	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 11-AS-20240103084316

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: 01/10/2024

NARRATIVE

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Based on the evidence gathered and interviews conducted, and records reviewed, 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; therefore, the allegation of “Licensee does not keep facility elevators maintained in operating condition” is unsubstantiated.

Allegation: Staff do not respond to residents' call buttons in timely manner

This investigation revealed following that interviews conducted with Eight (8) out of seventy-five (75) residents do not have issues with call buttons. Interviews conducted with Seven (7) out of forty-seven (47) staff members corroborated that they respond to all residents call buttons. Based on LPA interviews Seven (7) out of forty-seven (47) staff members, specifically, S#4. There is a logbook report 00967 Brookdale ocean house - Santa Monica, ca 90405-2299 task name: nurse call/e-call systems: in-house testing of nurse call systems last 12 months report was generated and provide at today's visit: 2024-01-10 due date 12/31/2023; 11/30/2023; 10/31/2023; 9/30/2023; 8/31/2023; 7/31/2023; 6/30/2023; 5/31/2023; 4/30/2023; 2/28/2023; 1/31/2023 history as of 01/10/24 11:13 am showing alerts. displaying the last 30 days. LPA confirmed the above dates and processes of the facility being taken when call buttons are issued to the facility's main front desk. LPA confirmed four (4) pagers in use by care staff.

Based on the evidence gathered and interviews conducted, and records reviewed, 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; therefore, the allegation of "Staff do not respond to residents' call buttons in timely manner” is unsubstantiated.

Allegation: Staff does not provide resident with timely meals

This investigation revealed following that interviews conducted with Eight (8) out of seventy-five (75) residents do receive their meals on time. Interviews conducted with Seven (7) out of forty-seven (47) staff members corroborated that all residents are provided meals in a timely fashion. Based on interview with conducted with S# 2 revealed that there is a resident nutrition tracker. This item has all the information pertaining to the facility residents. Name, Location, and diet. LPA received documents showing recent menus 2024. Also reviewed were the recipes for residents, which contain how the facility prepares, hold the facility food, how the recipe applies to each diet restriction, how much to serve, and nutritional values. All menus and recipes reviewed come from the Crandall Corporation of Registered Dieticians. Continued 9099-C

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David Espana	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 11-AS-20240103084316

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: 01/10/2024

NARRATIVE

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Based on interview with S#2 Room Service is available all day, but residents are asked to submit their orders in a timely fashion, (the day before, or, the meal prior) so they may receive it when expected. If resident places an order last minute, or during meal service, which the facility has residents that consistently practice their right, the residents are then placed on a waiting list of those residents who submitted their tickets first.

LPA reviewed the most current schedule for meals. Broken down into three categories. Servers, cooks, and dishwashers. According to S#2 production works as follows: There are three (3) servers for breakfast, lunch and dinner. One acts primarily as room service, and once all trays have been delivered, join the other two servers on the dining room floor.

There are three (3) cooks for the course of the daily operation, plus the Dining Services Director (Four in all).

First cook comes at 5:30am-1:30pm, second cook comes from 8am-4:30pm, and last cook comes from 11am-7:00pm. Dining Director comes from 10am-7:00pm but is here until 8pm.

Dishwashers: The first dishwashers come from 7am-2:30pm, and the last one come from 3pm-8pm.

Dining room hours- All day dining from 7:30am-6:30pm. During these hours the facility serves a side menu consisting of omelets, burgers, assorted sandwiches, fish and chips, and pasta.

LPA also confirmed the special menus for Breakfast, lunch and dinner are as follows; 7:30am-9:30am, 11:30am-1:30pm, and 4:30pm-6:30pm. Snacks are available after hours consisting of sandwiches, fruits, and yogurt. Juice and Soda Fountain, which also contains filtered water is available to residents 24/7.

Based on the evidence gathered and interviews conducted, and records reviewed, 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; therefore, the allegation of “Staff does not provide resident with timely meals” is unsubstantiated.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David Espana	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024

LIC9099 (FAS) - (06/04)

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