306002915-10-12-2023-22-AS-SSAS-CX4VUD-20231030164433

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306002915
Report Date: 10/12/2023
Date Signed: 10/12/2023 02:52:03 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
09/15/2020 and conducted by Evaluator Joseph Alejandre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200915080631

FACILITY NAME:	BROOKDALE ANAHEIM		FACILITY NUMBER:	306002915
ADMINISTRATOR:	ED SILVA		FACILITY TYPE:	740
ADDRESS:	200 N DALE ST		TELEPHONE:	(714) 761-5771
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92801
CAPACITY:	140	CENSUS: 103	DATE:	10/12/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Mink Medina, Health and Wellness Director		TIME COMPLETED:	03:34 PM

ALLEGATION(S):

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Staff are not providing the care necessary to meet resident's needs.
Resident was not accorded dignity in her relationships with staff.
Facility did not provide resident's representative with proper notification of rate increases.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to deliver the findings of the complaint investigation into the allegations listed above. LPA met with the Health and Wellness Director, Mink Medina and explained the reason for the visit. The investigation into the allegation, staff are not providing the care necessary to meet resident's needs, revealed the following. It was reported that Resident 1 (R1) fell on 9/14/20 and staff did not assist. Staff interviewed reported R1 did not fall in September. A review of special incidents reports for the facility for September 2020 do not show any incident reports for R1. It was alleged that R1 was left on the floor after the fall and staff did not assist R1. 4 out of 4 staff interviewed denied this report. R1 refused to be interviewed. It was reported that staff made R1 stand up without assistance during transfers which resulted in R1 falling on 9/14/20. 4 out of 4 staff interviewed denied this report.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023

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-20200915080631

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: 10/12/2023

NARRATIVE

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Based on the evidence gathered the allegation staff are not providing the care necessary to meet resident’s needs is deemed unsubstantiated, although the allegations may have happened or are valid, there is no preponderance of evidence to prove the alleged violation did or did not occur.

The investigation into the allegation, resident was not accorded dignity in her relationships with staff, revealed the following. It was reported that staff spoke inappropriately to R1. No specific details were provided concerning this allegation. 4 out of 4 staff interviewed who assist R1 denied this report. R1 refused to be interviewed. There is no evidence to support the allegation, therefore the allegation, resident was not accorded dignity in her relationships with staff is deemed unsubstantiated, although the allegations may have happened or are valid, there is no preponderance of evidence to prove the alleged violation did or did not occur.

The investigation into the allegation, facility did not provide resident's representative with proper notification of rate increases, revealed the following. R1’s level of assistance increased after their injury on 2/20/20 (see complaint #22-AS-20200227151034). The facility staff reported R1 needed additional assistance when using the restroom due to mobility issues and required a textured modified diet. Staff interviewed reported the changes were needed and reflected the proper level of care for R1. Facility staff reported that R1’s responsible party was called and never responded, and letters were sent to notify R1's responsible party of the increase. A review of records showed a copy of the letter sent to R1’s responsible party informing them of the rate increase. The records also showed the rate increase form and the mailing address used. Facility staff interviewed reported that R1’s responsible party never contacted the facility about the care plan or rate increase. R1’s responsible party reported they never received anything from the facility about the care plan or rate increase. Based on the information gathered the allegation, facility did not provide resident’s representative with proper notification of rate increases, is deemed unsubstantiated, although the allegations may have happened or are valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted and a copy of the report provided.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023

LIC9099 (FAS) - (06/04)

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