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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601778
Report Date: 05/07/2024
Date Signed: 05/07/2024 01:07:30 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 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
05/01/2024 and conducted by Evaluator Jose Villalobos
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240501165455
FACILITY NAME:BROOKDALE UPTOWN WHITTIERFACILITY NUMBER:
198601778
ADMINISTRATOR:PRECIOSA (SUZIE) MAGPAYOFACILITY TYPE:
740
ADDRESS:13250 E PHILADELPHIA STTELEPHONE:
(562) 945-3904
CITY:WHITTIERSTATE: CAZIP CODE:
90601
CAPACITY:280CENSUS: 110DATE:
05/07/2024
UNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Executive Director Suzie MagpayoTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Staff failed to properly assess residents after falls
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jose Villalobos conducted an initial complaint investigation visit for the allegation listed above. LPA met with Executive Director Suzie Magpayo and the purpose of the visit was discussed.

During todays visit, LPA Villalobos conducted the following: toured the physical plant which included all (4) floors of the facility, common areas, patios, and dining area. LPA interviewed residents #2-#7 (R2-R7) and Staff #1-#7 (S1-S7). LPA reviewed and collected copies incident reports regarding resident falls for the last 2 months. LPA collected documents from R1-R3's files which included their physicians report, Care plan and any Facesheet. R1 is unavailable for interview. The Investigation revealed the following:

Continued on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose VillalobosTELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2024
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 2
Control Number 28-AS-20240501165455
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: 05/07/2024
NARRATIVE
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In regards to the allegation "Staff failed to properly assess residents after falls" it is alleged that the multiple residents have fallen in the facility and staff don't do anything about it. (7) of (7) Staff interviewed denied the allegation. (6) of (6) Residents interviewed could not corroborate the allegation. Interviews from staff state that when a resident falls, witnessed or unwitnessed, they are assessed by the facilities med techs or nurse immediately. The person assessing the resident will call paramedics for the residents unless the resident express they do not want paramedic assistance. The fall is then noted and an incident report created. The family, physician, and Licensing is then notified. Depending on the situation, the facility nurse will make updates to the residents care plan going forward. LPA file review shows that there were (3) falls in the last 2 months. LPA reviewed the Incident reports created and sent into Licensing. Each report details whether the fall was unwitnessed or witnessed, that the resident was assessed, who assisted the resident, and what assistance was provided. The report also notes whether a change to the residents plan of care would be completed. Interviews with R2 and R3 confirmed the information on the incident reports involving them. All resident interviews shows that they believe staff will assist residents immediately once they are aware of a fall. LPA was not provided proof of which residents were not being assessed and assisted with properly by staff. Based on interviews, observations, and record review, there was not enough supportive evidence to concur with the reported allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the allegation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit Interview conducted and copy of this report was provided.
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose VillalobosTELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2024
LIC9099 (FAS) - (06/04)
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