306002915-2-28-2023-22-AS-AORZ-CPGUTU-20230228145230

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306002915
Report Date: 02/16/2023
Date Signed: 02/28/2023 12:41:12 PM

Unsubstantiated

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
01/06/2023 and conducted by Evaluator Andrea Mendivil

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230106134321

FACILITY NAME:	BROOKDALE ANAHEIM		FACILITY NUMBER:	306002915
ADMINISTRATOR:	TROY BYINGTON		FACILITY TYPE:	740
ADDRESS:	200 N DALE ST		TELEPHONE:	(714) 761-5771
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92801
CAPACITY:	140	CENSUS: 94	DATE:	02/16/2023
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Troy Byington - Executive Director		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Resident was administered medication in error.
Facility staff attempted to sexually assault resident.
Resident's jewelry was stolen.

INVESTIGATION FINDINGS:

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On this day Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to deliver findings for complaint control # 22-AS-20230106134321. LPA was greeted and granted entry into facility by Troy, Executive Director and explained the reason for the visit.

The department received a complaint on 01/06/2023 and the initial visit was on 01/13/2023. During the course of the investigation, the department interviewed staff and residents as well as obtained copies of physician reports, medication list, admission agreement, and staff statements. Regarding the allegations resident was administered medication in error, facility staff attempted to sexually assault resident and resident's jewelry was stolen, the investigation revealed the following:

In regards the the allegation that resident was administered medication in error. It was reported that facility staff gave a resident incorrect medication. CONT on 9099-C dated 02/16/2023

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-4084
LICENSING EVALUATOR NAME: Andrea Mendivil	TELEPHONE: 714-703-2738
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023

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-20230106134321

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: 02/16/2023

NARRATIVE

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Interviews with 3 out of 4 residents indicate they have not had issues with receiving incorrect medications. The last resident handles their own medication and could not provide an answer.

It was reported that staff 1 and staff 2 (S1 and S2) attempted to enter Resident 1s (R1) bed during the middle of the night. R1 reported that they said "NO" and the staff stopped. Interviews with 3 out of 4 residents stated they have not had any issues with staff initiating sexual advances or trying to enter their beds. S1 and S2 both deny attempting to enter R1's bed on any occasion. It has been reported that R1 has acted sexually inappropriate with staff and residents. R1 has been told on multiple occasions to stop the behavior and now care can only be provided if there are two staff members present. During a visit dated 02/08/2023 LPA Lyman interviewed R1 and R1 was sexually inappropriate with LPA Lyman. LPA Lyman ended the interview due to R1's behavior.

It was reported that R1 sometime in November 2022 was being transported to the shuttle and in the process of getting on the bus their ring went missing. Staff 3 (S3) reported they searched the bus and surrounding area and could not locate the ring. Based on interviews a police report was filed but there was no case number or officers information provided. LPA Mendivil requested information from the Anaheim Police Department and no information was provided. Interviews with 3 out of 4 residents stated they have not had any issues with theft.

Based on the preponderance of evidence through interviews and record review the allegations the resident was administered medication in error. that facility staff attempted to sexually assault resident and resident's jewelry was stolen are UNSUBSTANTIATED, meaning that although the allegation may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violation occurred. This agency has investigated this complaint.

No deficiencies cited.
An exit interview was conducted and a copy of this report and confidential names list was provided

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-4084
LICENSING EVALUATOR NAME: Andrea Mendivil	TELEPHONE: 714-703-2738
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2023

LIC9099 (FAS) - (06/04)

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