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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306001000
Report Date: 08/12/2021
Date Signed: 08/12/2021 03:08:05 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/04/2021 and conducted by Evaluator Kimberly Lyman
COMPLAINT CONTROL NUMBER: 22-AS-20210804130347
FACILITY NAME:BROOKDALE VALLEY VIEWFACILITY NUMBER:
306001000
ADMINISTRATOR:DANIEL LINESFACILITY TYPE:
740
ADDRESS:5900 CHAPMAN AVETELEPHONE:
(714) 898-3524
CITY:GARDEN GROVESTATE: CAZIP CODE:
92845
CAPACITY:160CENSUS: 58DATE:
08/12/2021
UNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Daniel LinesTIME COMPLETED:
03:35 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not responding to resident needs.
Resident dishes are left in the hallway.
Staff are sleeping in common areas.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Kimberly Lyman conducted an unnanounced complaint visit to initiate an investigation into the above allegations. LPA identified herself and discussed the purpose of the visit with Executive Director Daniel Lines.
During the course of the investigation, LPA toured the facility, interviewed staff and residents as well as reviewed and obtained pertinent documentation such as physician reports, diet modifications and staff schedule. Regarding the allegations that resident dishes are left in the hallway, staff are not responding to resident's needs and staff are sleeping in common areas, the investigation revealed the following: LPA toured the facility and did not observe any dishes in the hallway. While all witnesses confirmed seeing dishes in the hallway from time to time, all witnesses interviewed stated they are picked up as soon as possible. Witnesses state residents place the trays outside their rooms for pickup. Eight out of eight witnesses interviewed indicate no observation of anyone choking in the facility. Resident 5 (R5) denies any incident with choking. Residents 1-4 have physician ordered diet modifications that facility states are being adhered to. LPA observed Residents 1 and 2 eating lunch and the food provided CONTINUED ON LIC 9099C DATED 08/12/2021.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly LymanTELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021
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 2
Control Number 22-AS-20210804130347
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: BROOKDALE VALLEY VIEW
FACILITY NUMBER: 306001000
VISIT DATE: 08/12/2021
NARRATIVE
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followed the physician order. LPA observed R2 actively eating as well as R1. Facility states full assistance is provided to R3 at meal time effective 08/09/2021. Prior to that date facility was providing general assistance with eating. Facility administrator indicates staffing shortages in the dining room and facility is actively hiring. Kitchen staff indicate all departments are pitching in to help out at meal times and they are getting everything covered. Six out of six witnesses interviewed regarding staff sleeping, deny ever seeing a staff member asleep. Therefore, the allegations are deemed UNFOUNDED, meaning the allegations are false, could not have happened and/or is without a reasonable basis. An exit interview was conducted with Executive Director and a copy of this report was provided.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly LymanTELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2