198204758-10-3-2024-11-AS-UCOL-DA4VWW-20241016164836

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198204758
Report Date: 07/19/2024
Date Signed: 10/03/2024 01:37:36 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
08/15/2023 and conducted by Evaluator Mario Leon

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20230815103818

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: 82	DATE:	07/19/2024
		UNANNOUNCED	TIME BEGAN:	08:54 AM
MET WITH:	Helen Lee, Executive Director		TIME COMPLETED:	03:40 PM

ALLEGATION(S):

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Staff mishandled a resident's medication while in care
Staff did not provide adequate supervision to a resident
Staff did not seek timely medical attention for a resident

INVESTIGATION FINDINGS:

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This is an amendment of the complaint investigation report dated 07/19/2024. The purpose of this amendment is to provide additional evidence obtained from records reviewed during the investigation. This amendment does not change the findings and the findings remain unsubstantiated. On 07/19/2024 Licensing Program Analyst (LPA) Mario Leon conducted a subsequent, unannounced, complaint visit to the above-mentioned facility at 9:00AM. LPA arrived at facility and was met by, Helen Lee, Executive Director (S1), and the purpose of the visit was explained.
The investigation consisted of the following: On 10/03/24 LPA arrived at the facility at 09:30 to deliver this amended document. On 08/23/23 LPA obtained and reviewed facility documents, which included staff facility roster and facility resident roster and copies of resident’s medication admission record (MAR) (R1) and LPA interviewed four (4) residents and four (4) staff. On 07/19/24 LPA conducted a subsequent, unannounced, complaint visit to the above-mentioned facility at 9:00AM. LPA arrived at facility and was met by, Helen Lee, Executive Director (S1). LPA was given the Personnel Report (LIC500) and Register of Facility Clients/Residents and LPA interviewed eight (8) residents and two (2) staff. Report continues, see LIC9099C.

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Mario Leon	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2024

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-20230815103818

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: 07/19/2024

NARRATIVE

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The investigation revealed the following:

Regarding the allegation: "Staff mishandled a resident's (R1) medication while in care". Interviews revealed that two (2) out of two (2) staff and eight (8) out of eight (8) residents have denied the allegation had taken place. Record reviews indicate that one of R1’s medications has two sets of administration records on file for August 2023. The first set of the medication was self administered on 08/01/23 and was discontinued on 08/02/23 and the second set of medication administration record indicates that the same medication was resumed, and administered on, 08/03/23 – 08/22/23. Based on record reviews and interviews conducted, the preponderance of evidence standard has not been met. Therefore, the above allegation is found to be Unsubstantiated.

Regarding the allegation: "Staff did not provide adequate supervision to a resident". Interviews revealed that two (2) out of two (2) staff and eight (8) out of eight (8) residents have denied the allegation had taken place, R1 indicated that they do not have any issues with the supervision being provided by staff. Record reviews indicate that one of R1’s medications has two sets of administration records on file. The first set of the medication was self administered on 08/01/23 and was discontinued on 08/02/23 and the second set of medication administration record indicates that the same medication was resumed, and administered by staff, on the dates of 08/03/23 – 08/04/23 and was self administered from 08/05/23 – 08/22/23. Based on record reviews and interviews conducted, the preponderance of evidence standard has not been met. Therefore, the above allegation is found to be Unsubstantiated.

Regarding the allegation "Staff did not seek timely medical attention for a resident". It has been alleged that it took staff 1 hour to respond to residents' medical emergency(ies)”. Interviews revealed that two (2) out of two (2) staff and seven (7) out of eight (8) residents have denied the allegation had taken place. Record reviews indicated the following: the facilities staff roster showed adequate number of staff present and staff records indicated that staff have been properly trained for the job duties at hand. Specificially, under the segments of first aid and fall-risk management. Based on record reviews and interviews conducted, the preponderance of evidence standard has not been met. Therefore, the above allegation is found to be Unsubstantiated.

No deficiencies were cited. An exit interview was held with Helen Lee, Executive Director (S1), and a copy of this report has been provided.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Mario Leon	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2024

LIC9099 (FAS) - (06/04)

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