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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198204758
Report Date: 03/29/2023
Date Signed: 03/29/2023 03:09:42 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 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
03/21/2023 and conducted by Evaluator Perry Scott
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20230321151417
FACILITY NAME:BROOKDALE OCEAN HOUSEFACILITY NUMBER:
198204758
ADMINISTRATOR:PARK, THOMASFACILITY TYPE:
740
ADDRESS:2107 OCEAN AVETELEPHONE:
(310) 399-3227
CITY:SANTA MONICASTATE: CAZIP CODE:
90405
CAPACITY:150CENSUS: 72DATE:
03/29/2023
UNANNOUNCEDTIME BEGAN:
10:27 AM
MET WITH:TIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Facility equipment is in disrepair
INVESTIGATION FINDINGS:
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On 03/29/2023, Licensing Program Analyst (LPA) Perry Scott conducted an initial complaint investigation to address the allegation listed above. LPA Scott met with Holly Rice, Associate Executive Director, and explained the purpose of this visit is to gather information for the complaint and deliver findings.

On 03/29/2023, the investigation consisted of the following:

LPA Scott conducted a tour of the facility grounds. The facility is a 10-story high-rise apartment building located in a residential beach neighborhood. The facility is licensed for a capacity of 150 non-ambulatory residents; with a hospice waiver for 5. The facility consisted of the following: 116 apartment units/with bathrooms with 2 elevator shafts. LPA interviewed the Assistant Executive Director, residents, reviewed records, and delivered findings. LPA Scott requested the following documents: 1) A copy of the staff roster, 2) a copy of the resident roster, 3) Any elevator repair invoices or repair proposals, and certificate of liability insurance for the elevators.

The investigation revealed the following: Regarding the allegation: Facility equipment is in disrepair.

Continued on LIC9099-C

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Perry ScottTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023
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-20230321151417
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: BROOKDALE OCEAN HOUSE
FACILITY NUMBER: 198204758
VISIT DATE: 03/29/2023
NARRATIVE
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LPA spoke with Holly Rice, (S1) Assistant Executive Director, and she reported that the one elevator has been out service and that parts for the elevator were on back order. (S1) submitted invoices that show the elevator has been serviced and maintained. The facility uses TK Elevator Corporation and has the Gold-Full Maintenance package with phone monitoring, as a warranty, to service both elevators. The elevator was last serviced on 03/01/23, 02/14/23, 02/01/23, 01/24/23, 01/18/23, 01/01/23, 12/28/22, 12/01/22, 11/01/22, 10/01/22, 09/20/22. On each occasion parts were ordered, maintenance completed, and the elevator was returned to service.

The elevator has history of service problems. S1 reported that there are plans to have both elevators replaced, but the elevator that is down now should take approximately twelve weeks to complete. S1 also reported that the new Executive Director, Matan Burstyn, who will officially start on 03/30/23; is planning to have a meet and greet on that day and announce that both elevators will be replaced.

On 03/29/23, LPA toured the laundry areas with maintenance technician (S2) and S1. On the 7th and 3rd floor LPA observed that the washing machines were out of service, and have signs posted. LPA was presented with two work orders created on 02/25/23 & 03/24/23 to be completed by the first weekend in April of 2023.

On 03/29/23 LPA was presented with a construction agreement between owner and contractor by S1 which details elevator modernization that will commence on 4/1/23 with a completion date 4/1/25 to have both elevators replaced. The construction will allow the use of one elevator while the new elevator is being installed, explained S1. S1 also indicated that CCLD knows about the issue because another LPA was here last year investigating it as well. LPA advised that the fire department needs to be made aware of the issues barring any emergency that may arise.

On 03/29/23 LPA interviewed residents R1-R5, and 5 of 5 residents confirmed the allegation to be true. 5 of 5 confirmed that one of the elevators has been out of service for months. They all confirm that the elevator has a history of breaking down, however when it does, the facility does call to have it repaired. But added that it takes a long time to get parts in stock which leaves them feeling inconvenienced. Additionally, 5 of 5 of the residents confirmed that they also have issues with the washing machines. In that they too have to be fixed often.

Based on LPA’s observation, interviews conducted, and records reviewed, the preponderance of evidence standard has been met. Therefore, the above allegation: Facility equipment is in disrepair, are found to be substantiated. California Code of Regulations, Title 22, Division (6) and chapter (8) are being cited on the attached LIC 9099D.

An exit interview was conducted. Plans of corrections were developed. A copy of this report and appeal rights were given to Holly Rice, Associate Executive Director.

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Perry ScottTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20230321151417
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: BROOKDALE OCEAN HOUSE
FACILITY NUMBER: 198204758
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/29/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/07/2023
Section Cited
CCR
87303(a)
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87303 Maintenance and Operation
a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by:
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Facility will submit documentation from TK Elevator Corp verifying when the elevator and washing machine repairs will be completed by POC due date. Additionally, Facility will develop a plan to address how they will ensure the residents’ personal rights are not violated due to their inability to access the elevator. POC letters must be sent to LPA via email or fax by POC due date.
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Based on Interviews conducted, record review and observation. All residents and staff unanimously confirmed the allegation to be true and there is a history issues. A review of service request shows frequent service calls due to the elevator malfunction and washing machine issues. LPA observed one of the two elevators out of service, as well as two washing machines in need of service.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Perry ScottTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3