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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601778
Report Date: 04/15/2021
Date Signed: 04/15/2021 04:33:24 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 CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/12/2020 and conducted by Evaluator Mary G Flores
COMPLAINT CONTROL NUMBER: 28-AS-20201112113226
FACILITY NAME:BROOKDALE UPTOWN WHITTIERFACILITY NUMBER:
198601778
ADMINISTRATOR:MAGPAY, PRECIOSA (SUZIE)FACILITY TYPE:
740
ADDRESS:13250 E PHILADELPHIA STTELEPHONE:
(562) 945-3904
CITY:WHITTIERSTATE: CAZIP CODE:
90601
CAPACITY:280CENSUS: 112DATE:
04/15/2021
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Preciosa Magpay - AdministratorTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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2
3
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5
6
7
8
9
Facility is in disrepair
Facility is not clean
INVESTIGATION FINDINGS:
1
2
3
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5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Mary Flores initiated a complaint investigation for the allegations listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Preciosa Magpay, the facility administrator.

The investigation consisted of the following: On 11/17/20 LPA Flores conducted telephone interview with the administrator (staff#1,S1), and a video call tour which consisted of a review of facility's physical plant; dining room, kitchen, hallways, and rooms #101, 123, 127, 208, 220, 232, 308, 316, 329, 407, 439, 441, 443 which were ramdonly choosen. The LPA also requested copies of staff and resident roster, service repair invoices for roof repairs and plumbing, clening logs for housekeeping for the last month, housekeeper job description, exterminator invoices/service receipts, and any in service training regarding housekeeping COVID 19 updates. On 1/12/21 LPA Flores contacted contractor company. On 3/24/21 LPAs Flores and Cynthia Chan conducted an additional tour of facility and interviewed Resident #2,#3,#4,#5,#6,#7 (R2,R3,R4,R5,R6,R7). On 3/29/21 interviewed with resident #8,#9,#10,#11,#12(R8,R9,R10,R11,R12) and staff #2,#3,#4,#5,#6,#7 (S2,S3,S4,S5,S6,S7). (CONTINUED ON 9099C)
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Rebecca OrendainTELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Mary G FloresTELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2021
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 5
Control Number 28-AS-20201112113226
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 CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: BROOKDALE UPTOWN WHITTIER
FACILITY NUMBER: 198601778
VISIT DATE: 04/15/2021
NARRATIVE
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The investigation revealed the following: Regarding allegation; Facility is in disrepair. It is alleged roof and ceiling leaks in resident's room. During interviews 2 out of 11 residents interview stated to have experiences leaks coming from their ceiling. 1 out of 11 has not have leaks but can see residue of water leak in celing and 8 out 11 residents have not experience any leaks in their rooms. Interviews with staff revealed; 3 out of 7 staff interview stated to have observed leaks in residents rooms and 4 out of 7 staff have not observed any leaks in the residents rooms. Interview with contracting company for roof repairs verify that there had been a leak in room #441 on 12/30/20 after company had repair roof areas on 8/10/20. Contractor stated facility is under warranty for repairs and its likely leaks could arise in different areas. LPA review invoice on 11/17/20 for repairs done on 8/10/2020 for room #441.

Based on LPA's observations, interviews, and file review conducted the preponderance of evidence standard has been met, therefore the above allegation(s) are found SUBSTANTIATED.

The investigation revealed the following: Regarding allegation; Facility is not clean. It is alleged staff do not readily remove the residents discarded trash. During interviews, 7 out of 11 residents interview stated to take the trash outside their door before 7:00pm and place it there for night shift housekeeper to pick up 1 out 11 residents stated to not like leaving the trash outside and walks it to the nearest bin, and 3 out of 11 residents were assisted with their trash. Interviews with staff revealed; 6 out of 7 staff interviewed state that facility's protocol prior COVID 19 has been for residents to place their trash outside their door every evening by 7:00pm for it to be picked up once the night housekeeper begins shift around 10:00pm. 1 out of 7 staff stated to not know about trash pick up. LPA review staff schedule and night shift staff begins shift at 10:30pm until 6:00am.

Based on LPA's observations, interviews, and file review conducted the preponderance of evidence standard has been met, therefore the above allegation(s) are found SUBSTANTIATED. California Code of Regulations Title 22, Division 6 and Chapter 8 are being cited in the attached LIC 9099D.

Exit interview was conducted with Administrator Preciosa Magpay. A copy of the report, LIC 9099D, and Appeal Rights was provided via email to the Administrator for signature.
SUPERVISOR'S NAME: Rebecca OrendainTELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Mary G FloresTELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 28-AS-20201112113226
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 CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: BROOKDALE UPTOWN WHITTIER
FACILITY NUMBER: 198601778
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/15/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/29/2021
Section Cited
CCR
8730(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 evidence by:
1
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3
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5
6
7
Facility will ensure roof is repaired. Facility has submitted invoice for repairs in roof and will submit pictures of repairs of ceiliing in rooms #441, 421, 401 pictures to be submitted to the department by 4/29/21.
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Based on observation, interviews, and file review facility did not ensure roof leaks were completely repair at facility as room #441, had a leak on 12/30/20 and ceiling water stains were observed in rooms # 441, 421,401 which poses a potential Health, Safety, or Personal Rights risk to persons in care.
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Type B
04/29/2021
Section Cited
CCR
87303(f)(1)
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87303 Maintenance and Operation; (f) Solid waste shall be...disposed of...: (1)... in a manner that will not permit the transmission of a communicable disease or of odors, create a nuisance, provide a breeding place or food source for insects or rodents.

This requirement is not met as evidence by:
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Facility will create a plan to eliminate leaving trash outside of hallway before being pick up by night shift staff. Plan will be submitted to the department along with certification on LIC 9098 by 4/29/21.
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Based on interviews facility's protocol is to have residents place trash for the day outside their door in hallway by 7:00pm to be pick up by night shift housekeeper, 7 out 11 residents place trash outside their door which poses a potential Health, Safety, or Personal Rights risk to persons in care.
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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: Rebecca OrendainTELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Mary G FloresTELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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 CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/12/2020 and conducted by Evaluator Mary G Flores
COMPLAINT CONTROL NUMBER: 28-AS-20201112113226

FACILITY NAME:BROOKDALE UPTOWN WHITTIERFACILITY NUMBER:
198601778
ADMINISTRATOR:MAGPAY, PRECIOSA (SUZIE)FACILITY TYPE:
740
ADDRESS:13250 E PHILADELPHIA STTELEPHONE:
(562) 945-3904
CITY:WHITTIERSTATE: CAZIP CODE:
90601
CAPACITY:280CENSUS: 112DATE:
04/15/2021
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Preciosa Magpay - AdministratorTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility has roaches
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Mary Flores initiated a complaint investigation for the allegations listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Preciosa Magpay, the facility administrator.

The investigation consisted of the following: On 11/17/20 LPA Flores conducted telephone interview with the administrator (staff#1,S1), and a video call tour which consisted of a review of facility's physical plant; dining room, kitchen, hallways, and rooms #101, 123, 127, 208, 220, 232, 308, 316, 329, 407, 439, 441, 443 which were ramdonly choose. The LPA also requested copies of staff and resident roster, service repair invoices for roof repairs and plumbing, clening logs for housekeeping for the last month, housekeeper job description, exterminator invoices/service receipts, and any in service training regarding housekeeping COVID 19 updates. On 1/12/21 LPA Flores contacted contractor company. On 3/24/210 conducted an additional tour of facility and interviewed Resident #2,#3,#4,#5,#6,#7 (R2,R3,R4,R5,R6,R7). On 3/29/21 interviewed with resident #8,#9,#10,#11,#12(R8,R9,R10,R11,R12) and staff #2,#3,#4,#5,#6,#7 (S2,S3,S4,S5,S6,S7).
(CONTINUED ON 9099C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Rebecca OrendainTELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Mary G FloresTELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 28-AS-20201112113226
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 CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: BROOKDALE UPTOWN WHITTIER
FACILITY NUMBER: 198601778
VISIT DATE: 04/15/2021
NARRATIVE
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2
3
4
5
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7
8
9
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12
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15
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32
The investigation revealed the following: Regarding allegation; Facility has roaches. It is alleged that the roach problem is still active and roaches are feasting in residents trash containers in their rooms. During interviews with residents 9 out of 11 residents stated to have not observed roaches in their rooms or trash cans and 2 out of 11 residents interview stated to have observed one random roach in their room. Interviews with staff revealed; 5 out of 7 staff interview stated to have not observed roaches in residents' rooms or facility and 2 out of 7 staff interviewed have observed a few roaches in one resident's room. During facility's tours LPA did not observed any roaches in the residents' kitchen, trash cans, facility's kitchen, or common areas. LPA reviewed pest control invoices and facility has pest control company service the facility once a month.

Based on LPA's interviews, conducted the preponderance of evidence standard has been met, therefore the above allegation(s) are found UNSUBSTANTIATED.

Exit interview was conducted with Administrator Preciosa Magpay and a copy of the report was email for signature.
SUPERVISOR'S NAME: Rebecca OrendainTELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Mary G FloresTELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 5