198601778-6-1-2021-28-AS-FFIS-C4J246-20210701170324

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601778
Report Date: 06/01/2021
Date Signed: 06/01/2021 03:06:12 PM

Substantiated

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
09/09/2019 and conducted by Evaluator Kruz Long

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20190909170457

FACILITY NAME:	BROOKDALE UPTOWN WHITTIER		FACILITY NUMBER:	198601778
ADMINISTRATOR:	MAGPAY, PRECIOSA (SUZIE)		FACILITY TYPE:	740
ADDRESS:	13250 E PHILADELPHIA ST		TELEPHONE:	(562) 945-3904
CITY:	WHITTIER	STATE: CA	ZIP CODE:	90601
CAPACITY:	280	CENSUS: 113	DATE:	06/01/2021
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Suzie (Preciosa) Magpayo (Executive Director)		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility has roaches.

INVESTIGATION FINDINGS:

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***This LIC9099 complaint report supersedes LIC9099 complaint report dated 09/11/19.****

LPA Kruz Long contacted Suzie (Preciosa) Magpayo via telephone to deliver complaint findings for the above allegation.

During a complaint site visit on 09/11/19, LPA obtained a copy of the Staff schedule, Resident roster, Pest control service records and toured the facility with Staff #1 and Staff #2 at 10:05 am. During the tour of the facility LPA briefly spoke with Residents #6 through #10 regarding roaches.

In regards to the allegation: Facility has roaches. After a tour of the facility, LPA sighted 1 roach carcass under the stairway in the parking garage area but the rest of the facility toured appears to be clean. Interviews with 3 of 5 Residents indicate there are sightings of roaches between long time spans. Continue to LIC9099C....

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Kruz Long	TELEPHONE: (323) 383-8117
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2021

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 28-AS-20190909170457

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: 06/01/2021

NARRATIVE

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***This LIC9099C complaint report supersedes LIC9099C complaint report dated 09/11/19.****

Based on LPA's observations and interviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D.

Exit interview conducted with Suzie (Preciosa) Magpayo and a copy of this report and appeal rights was emailed for signature.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Kruz Long	TELEPHONE: (323) 383-8117
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2021

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20190909170457

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: 06/01/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Request Denied Type B 06/02/2021 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	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 was not met as evidence by the following: LPA sighted 1 roach carcass under the stairway in the parking garage area and	1 2 3 4 5 6 7	Licensee shall provide proof of pest control services to the department by the POC date. *Note: LPA obtained proof of pest control service records. LPA also spoke with pest control company representative via telephone and verified that facility is being treated for any type of pest on a monthly basis.*
	8 9 10 11 12 13 14	interviews with 3 of 5 Residents indicate there are sightings of roaches.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Fernando Fierros	TELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Kruz Long	TELEPHONE: (323) 383-8117
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2021

LIC9099 (FAS) - (06/04)

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