306001000-1-12-2023-22-AS-SSAS-CN9SRV-20230120130657

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306001000
Report Date: 01/12/2023
Date Signed: 01/12/2023 03:21:15 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 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
11/15/2022 and conducted by Evaluator Kevin Saborit-Guasch

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20221115162302

FACILITY NAME:	BROOKDALE VALLEY VIEW		FACILITY NUMBER:	306001000
ADMINISTRATOR:	DANIEL LINES		FACILITY TYPE:	740
ADDRESS:	5900 CHAPMAN AVE		TELEPHONE:	(714) 898-3524
CITY:	GARDEN GROVE	STATE: CA	ZIP CODE:	92845
CAPACITY:	160	CENSUS: 52	DATE:	01/12/2023
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Melissa Weibel, Executive Director		TIME COMPLETED:	03:35 PM

ALLEGATION(S):

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Facility is increasing residents rent without proper notice

INVESTIGATION FINDINGS:

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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch conducted an unannounced inspection visit to follow up on the investigation of the allegation listed above and deliver findings in the investigation of the allegation. LPA was greeted and granted entry by Executive Director Melissa Weibel after explaining the purpose of the visit and detailing the allegation being investigated at this time.

It was alleged that Facility is increasing residents rent without proper notice. LPA Saborit-Guasch conducted a joint initial complaint investigation visit along with LPA Alvaro Ramirez Jr. on 11/22/2022. A follow-up visit was then conducted on 01/12/2023. During the investigation, the Department interviewed the administrator, the (now former) Health and Wellness Director along with the alleged victim as well as reviewed and obtained pertinent documentation including Progress Notes, Individual Needs and Services assessments and Admission Agreement.

CONTINUED ON FORM LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023

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-20221115162302

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: BROOKDALE VALLEY VIEW	FACILITY NUMBER: 306001000
	VISIT DATE: 01/12/2023

NARRATIVE

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CONTINUED FROM FORM LIC9099

Regarding the allegation that Facility is increasing residents rent without proper notice, the following was concluded: On multiple instances following resident R1's admission to the facility, the Personal Service Rate was reassessed due to documented changes in condition observed in the resident's displayed behavior in the facility. Due to multiple rescheduling of the care conferences during which the rate change is announced, the increased rate billed from 09/06/2022 until 10/30/2022 was charged over one single month, which prompted confusion with resident R1 thinking that the increase was even more substantial than she had been informed.

After the Brookdale Regional Nurse reviewed the previous assessments and reassessed resident R1 on 11/30/2022, the Personal Service Rate was brought back to the initially assessed level. Additional charges due to Behaviors adjustments that had previously been instated were removed effective immediately. A one-on-one meeting between the Executive Director and the resident was held and documented on 12/07/2022 to provide final clarification on the billing. A cost-of-living rate adjustment effective 02/01/2023 was also notified on 11/30/2022, giving the appropriate 60-day notice as indicated in the reviewed Admission Agreement.

Even though facility staff could have made sure to clarify the billing situation with resident, the interviews and records reviewed appear to indicate that adequate notice was given both prior to adjustments to the resident's Personal Service Rate as well as to cost-of-living adjustments to the Basic Service Rate, which was notified 60 days before the effective date.

Based on the evidence gathered during the investigation, the allegation that Facility is increasing residents rent without proper notice is deemed to be unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. An exit interview was conducted with the facility representative and a copy of this report was left at the facility.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023

LIC9099 (FAS) - (06/04)

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