198204758-8-11-2022-11-AS-UCOL-CK4PJK-20221011112141

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198204758
Report Date: 08/11/2022
Date Signed: 08/11/2022 10:04:24 PM

Unsubstantiated

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
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/11/2022 and conducted by Evaluator Don Senaha

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20220711140330

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: 79	DATE:	08/11/2022
		UNANNOUNCED	TIME BEGAN:	02:21 PM
MET WITH:	Joshua Castillo - Associate Executive Director and LVN Amanda Monroy		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility did not adhere to the Admission Agreement.
Resident's hygiene needs were not met.
Staff did not meet resident's needs while in care.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 08/11/2022 Licensing Program Analyst (LPA) Don Senaha initiated a subsequent complaint visit for the allegations listed above and to deliver findings. Today’s complaint investigation was conducted with Associate Executive Director Joshua Castillo.

On 07/21/2022 Licensing Program Analyst (LPA) Don Senaha initiated a complaint investigation for the allegations listed above. Today’s complaint investigation was conducted with Associate Executive Director Joshua Castillo.

The investigation consisted of the following: LPA requested service documents and interviewed residents (R1-R9) and staff (S1-S4).

A plant inspection of the facility was conducted.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Don Senaha
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2022

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-20220711140330

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
MONTEREY PARK, CA 91754

FACILITY NAME: BROOKDALE OCEAN HOUSE	FACILITY NUMBER: 198204758
	VISIT DATE: 08/11/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Investigation revealed:

Allegation: Facility did not adhere to Admission Agreement.

During the course of the investigation, LPA was unable to find any witnesses or documentation supporting the allegation above. There is no evidence that supports the facility did not adhere to Admission Agreement.

Residents (R1-R9) stated they have not had any issues with the facility adhering to their Admission Agreement. Associate Executive Director stated the facility is month to month for rent and requires a 30-day written notice from a resident to get reimbursement of the deposit. LPA observed the Admission Agreement signed and dated with specified date agreed upon for “Schedule of Services and Rates to commence”. LPA reviewed previous complaint 11-AS-2022113153405 which was a similar allegation stated in a different verbiage and LPA investigated found the complaint to be “unsubstantiated”.

Based on LPA’s interviews conducted and records reviews, the preponderance of evidence standard has not been met. 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 is Unsubstantiated

Allegation: Resident’s hygiene needs were not met.

During the course of the investigation, LPA was unable to find any witnesses or documentation supporting the allegation above. There is no evidence that resident’s hygiene needs were not meet.

LPA interviewed residents (R1-R9) who stated no issues with ADLs being met at the facility. Residents (R1-R9) stated they are given a comfortable living environment at the facility. Resident (R2, R7-R9) who get help with showers have no issues with the shower schedule and staff assisting. Staff (S2-S4) stated residents ADLs are being met on a daily basis. Staff (S2-S4) stated they assist residents with showers according to the scheduled services. LPA obtained a copy of a Personal Service Plan (PSP) which includes personalized assisted living based on an individual preferences. This PSP is itemized and includes but is not limited to assistance with medications, showering or bathing, bathroom, escort and mobility and dressing and grooming.

Based on LPA’s interviews conducted and records reviews, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is Unsubstantiated

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Don Senaha
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 11-AS-20220711140330

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
MONTEREY PARK, CA 91754

FACILITY NAME: BROOKDALE OCEAN HOUSE	FACILITY NUMBER: 198204758
	VISIT DATE: 08/11/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Allegation: Staff did not meet resident’s needs while in care.

During the course of the investigation, LPA was unable to find any witnesses or documentation supporting the allegation above. There is no evidence that staff did not meet resident’s needs while in care.

Based on LPA’s interviews conducted and records reviews, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is Unsubstantiated

There were no deficiencies found at the time of the visit.

An exit interview was conducted with Joshua Castillo and a hard copy was provided.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Don Senaha
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3