306001000-1-15-2025-22-AS-AORZ-DDEM2J-20250130081337

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306001000
Report Date: 01/15/2025
Date Signed: 01/15/2025 11:16:51 AM

Unfounded

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
02/14/2024 and conducted by Evaluator Kimberly Lyman

COMPLAINT CONTROL NUMBER: 22-AS-20240214140414

FACILITY NAME:	BROOKDALE VALLEY VIEW		FACILITY NUMBER:	306001000
ADMINISTRATOR:	MELISSA WEIBEL		FACILITY TYPE:	740
ADDRESS:	5900 CHAPMAN AVE		TELEPHONE:	(714) 898-3524
CITY:	GARDEN GROVE	STATE: CA	ZIP CODE:	92845
CAPACITY:	160	CENSUS: 60	DATE:	01/15/2025
		UNANNOUNCED	TIME BEGAN:	10:16 AM
MET WITH:	Chiquita Morris		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

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Staff did not respond to resident's call in a timely manner
Staff utilizes an inappropriate lock on resident's door.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to deliver findings on the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the course of the investigation, LPA toured the facility and interviewed staff as well as reviewed and obtained pertinent documentation such as facility notes. Regarding the allegations that staff did not respond to resident's call in a timely manner and staff utilizes an inappropriate lock on resident's door, the investigation revealed the following: On 02/13/2024, Resident 1 (R1) requested staff to call 911 for knee pain. Administrator called 911 and Emergency Medical Services (EMS), Lynch Ambulance, arrived to the facility. EMS put the resident on a gurney and took the resident downstairs for transport. In the meantime, staff locked the resident's door with an exterior lock per resident request. Once downstairs, the resident declined transport as the resident requested transport to a hospital that was too far away. Resident did not want to go to Los Alamitos Medical Center as advised by EMS. EMS transported the resident back to the resident's room which had been locked per resident request. Staff in charge at the time had gone on break and had to be called. CONTINUED ON LIC 9099C DATED 01/15/2025

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:	DATE: 01/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2025

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 22-AS-20240214140414

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: 01/15/2025

NARRATIVE

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Once the staff was back, the door was unlocked. Two out of two staff state the elapsed time was approximately 10-15 minutes as the staff was on a break. Facility protocol is to have the staff in charge hold onto the key so no other staff/ residents can access the room when the resident is out. LPA observed the lock during the investigation. The lock is an exterior lock put on the doorhandle. Residents are able to open the door from the inside and exit while the lock is on the outside and LPA observed this firsthand. Administrator indicates that they have the locks on-site for those who want extra security for their rooms while out of the facility. R1 was one of the residents that would always request the lock when leaving the facility. Based on interviews conducted and observation, the allegations are deemed unfounded, meaning the allegations were false, could not have happened and/or is without a reasonable basis. Exit interview conducted and a copy of this report was provided to facility representative.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:	DATE: 01/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2025

LIC9099 (FAS) - (06/04)

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