198204758-8-24-2021-11-AS-EMAZ-C82RQT-20211022131403

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198204758
Report Date: 08/24/2021
Date Signed: 08/24/2021 04:40:27 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/15/2021 and conducted by Evaluator Stephanie Cifuentes

COMPLAINT CONTROL NUMBER: 11-AS-20210315160314

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:	DATE:	08/24/2021
		UNANNOUNCED	TIME BEGAN:	10:39 AM
MET WITH:			TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Resident sustained a death while in care
Staff do not properly maintain a resident's room while in care
Staff is not properly assisting the residents while in care
Residents are being mistreated while in care

INVESTIGATION FINDINGS:

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On 08/24/2021, Licensing Program Analyst (LPA) Stephanie CIfuentes conducted an unannounced subsequent complaint visit at this facility. LPA met with Thomas Rekowski, Executive Director and explained the purpose of today's visit is to deliver findings for the allegations listed above.

The investigation consisted of the following: On 3/16/2021 LPA Cifuentes spoke with administrator via Facetime, was given a tour of facility grounds and requested facility records. On 3/16/2021 tone of the allegations was accepted by the CCLD Investigation Unit and assigned to IB Investigator Robert Kujawa. On 4/14/2021, 6/8/2021 and 6/24/2021 Investigator Kujawa conducted interviews with staff, residents and witnesses. On 8/24/2021 LPA Cifuentes conducted interviews with Resident 4-Resident 8(R4-R8) and staff 1-staff 5(S1-S5)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021

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-20210315160314

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754

FACILITY NAME: BROOKDALE OCEAN HOUSE	FACILITY NUMBER: 198204758
	VISIT DATE: 08/24/2021

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:
Allegation: Resident sustained a death while in care

The complainant states (R1) died from neglect while in care of facility staff. IB Investigator Robert Kujawa reviewed records, interviewed staff and witnesses. and found that R1 did not sustain a death while in care of facility staff. Facility notes show that R1 contracted covid-19 and was transferred to a rehab facility. Upon R1’s return, several notes outline that resident was monitored for temperature, oxygen, body weakness and eating habits. Facility reached out to R1’s authorized representative regarding their medical condition and need for medical follow-up. R1 was hospitalized upon doctors’ orders and per facility notes R1 passed from covid-19 related pneumonia and had been out of the facilities care for 19 days at the time of their passing. IB Investigator Kujawa did not find any evidence of neglect in the residents’ care.

Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above.

Allegation: Staff do not properly maintain a resident's room while in care

The complainant reported that human waste was seen in bathroom of R2. IB Investigator Robert Kujawa spoke with R2 on 6/8/2021. Per R2, there has been no human waste on the floor of room. On 8/24/2021 LPA Cifuentes toured facility grounds and did not see or smell any human waste in residents’ rooms. On 8/24/2021 LPA Cifuentes spoke with residents R4-R8 and asked how often rooms were cleaned and if staff were properly maintaining their rooms. 5 out of 5 residents interviewed agreed that staff cleaned their rooms once per week and rooms were properly maintained. On 8/24/2021 LPA Cifuentes interviewed staff (S1-S5) regarding maintenance of resident’s rooms. 5 out of 5 staff stated rooms are cleaned minimum once per week and that residents’ rooms are properly maintained.

Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above.

Continued on 9099-C

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20210315160314

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754

FACILITY NAME: BROOKDALE OCEAN HOUSE	FACILITY NUMBER: 198204758
	VISIT DATE: 08/24/2021

NARRATIVE

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Allegation: Staff is not properly assisting the residents while in care

The complainant reports staff members are lazy and do not take good care of the residents. IB investigator Kujawa spoke with R2 on 6/8/2021, who stated they felt they get the care they need. On 8/24/2021 LPA Cifuentes spoke with residents R4-R8 about the assistance they received from facility staff. 4 out of the 5 interviewed residents stated they felt staff are properly assisting them. On 8/24/2021 LPA Cifuentes spoke with staff (S1-S5) regarding assistance to residents. Alld 5 staff felt they were properly assisting residents.

Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above.

Allegation: Residents are being mistreated while in care

The complainant reported overhearing R3 state that staff are mean to them. Per report by IB investigator Kujawa, no evidence was found through records or interviews of neglect of residents in care. On 8/24/2021 LPA Cifuentes interviewed residents R4-R8 and asked if staff were polite or if they mistreated them. 5 out of 5 resident stated staff are polite and did not feel they were being mistreated by staff. LPA Cifuentes interviewed staff on 8/24/2021 regarding politeness to residents and whether or not they felt residents were being mistreated. 5 out of 5 staff stated they were polite to residents an

Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above.

The Department’s investigation consisted of an inspection of the facility, observation, analysis of residents records, incident report, and interviews conducted and found no evidence to support the allegations: “Resident sustained a death while in care”, ”Staff do not properly maintain a resident's room while in care”, “Staff is not properly assisting the residents while in care”, “Residents are being mistreated while in care”.

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 Unsubstantiated.

An exit interview was conducted with Tom Rekowski and a copy of the report was provided by email.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021

LIC9099 (FAS) - (06/04)

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