306002915-8-24-2020-22-AS-LADS-BTL26S-20200918170733

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306002915
Report Date: 08/07/2020
Date Signed: 08/24/2020 11:11:59 AM

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
02/27/2020 and conducted by Evaluator Michelle Reed

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200227151034

FACILITY NAME:	BROOKDALE ANAHEIM		FACILITY NUMBER:	306002915
ADMINISTRATOR:	CARRIE GALLOWAY		FACILITY TYPE:	740
ADDRESS:	200 N DALE ST		TELEPHONE:	(714) 761-5771
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92801
CAPACITY:	140	CENSUS: 80	DATE:	08/07/2020
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Administrator Troy Byington		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Resident sustained a fracture while in care
Staff not responding to call button

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Michelle Reed met with Administrator Troy Byington via facetime due to COVID-19 precautionary measures to discuss the findings for the above allegations. The allegations were investigated by the Department. The investigation consisted of interviews conducted with the facility staff, Administrator, and witnesses as well as documentation. The following was determined:

The Department received allegations that resident sustained a fracture while in care and staff are not responding to call button.

The investigation revealed Resident #1(R1) sustained multiple falls at the facility. On 2/20/20, while being assisted with toileting needs inside their bathroom, R1 was left on the toilet by Staff #1(S1) for approximately 10 minutes. S1 left R1 to help another resident on a different floor. R1 became tired of waiting and tried to get back into their wheelchair and fell. R1 sustained a fractured right ankle. S1 stated while working overnight, she has left R1 on her own before and has gone to help other residents. S1 was the only caregiver working that

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 748-2936
LICENSING EVALUATOR NAME: Michelle Reed	TELEPHONE: (714) 743-4958
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2020

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-20200227151034

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 ANAHEIM	FACILITY NUMBER: 306002915
	VISIT DATE: 08/07/2020

NARRATIVE

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night in the assisted living section and she was responsible for taking care of 11 residents. S1 did not call another staff member (a med tech was on duty) for assistance with R1 when she left. Fall mitigation efforts were not put into place by the facility after the falls (no mats).

Call records for residents at the facility were reviewed for the week of 2/16/20-2/22/20 by LPA Michelle Reed. Records disclosed that call buttons were not answered in a timely manner by staff. Calls by residents were answered anywhere from 1 minute to 41 minutes and sometimes were not answered at all.

Based on the above, the preponderance of evidence standard has been met, therefore, the above allegations are found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 8), is being cited on the attached LIC9099D.

An exit interview was conducted with Administrator Troy Byington and a copy of this report was provided via email for review and signature. A hard copy will be kept on file.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 748-2936
LICENSING EVALUATOR NAME: Michelle Reed	TELEPHONE: (714) 743-4958
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2020

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20200227151034

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 ANAHEIM	FACILITY NUMBER: 306002915
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/07/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 08/08/2020 Section Cited CCR 87464(f)(1)	1 2 3 4 5 6 7	Basic Services- Basic Services at a minimum shall include care and supervision. Care and supervision means the facility assumes responsibility for, or provides or promises to provide in the future, ongoing assistance with activities of daily living without which the resident’s physical health, mental health, safety, or welfare would be endangered.	1 2 3 4 5 6 7	Licensee agrees to provide ongoing assistance to residents who need assistance with their activities of daily living. The assistance shall be provided to ensure that the residents physical health, mental health, safety and welfare are not endangered. This assistance will include providing more staff as needed to meet the needs of all residents.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: R1 is not able to care for her toileting needs and staff need to monitor her with toileting. On 2/22/20, S1 failed to provide R1 with toileting assistance. R1 was left unattended on the toilet for approximately 10 minutes. R1 got up on her own and fell. R1 sustained a fractured ankle.	8 9 10 11 12 13 14	Certification will be provided by the Licensee as proof of understanding of this subsection. Immediate civil penalty is assessed for $500 for the lack of supervision.
Type A 08/08/2020 Section Cited CCR 87468.2(a)(4)	1 2 3 4 5 6 7	Additional Personal Rights of Residents in Privately Operated Facilities-Residents in privately operated residential care facilities for the elderly shall have the right to care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee agrees to bring staff to sufficient numbers to ensure that calls for assistance by residents are answered in a timely manner. A plan to ensure that calls are answered timely will be provided to the Department.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: Staff failed to answer resident call buttons in a timely manner. Call records for residents were reviewed for the week of 2/16/20-2/22/20. The records disclosed that calls by residents were answered anywhere from 1 minute to 41 minutes and sometimes were not responded to at all.	8 9 10 11 12 13 14

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: Luz Adams	TELEPHONE: (714) 748-2936
LICENSING EVALUATOR NAME: Michelle Reed	TELEPHONE: (714) 743-4958
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2020

LIC9099 (FAS) - (06/04)

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