306002915-11-9-2023-22-AS-SSAS-CYAT89-20231207132954

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306002915
Report Date: 11/09/2023
Date Signed: 11/09/2023 03:01:35 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
05/05/2021 and conducted by Evaluator Joseph Alejandre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20210505114545

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: 108	DATE:	11/09/2023
		UNANNOUNCED	TIME BEGAN:	12:25 PM
MET WITH:	Troy Byington		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident was touched inappropriate by staff.
Resident has fallen multiple times while in care.
Staff are denying resident food.
Staff are not checking on resident in a timely manner.
Staff are not providing a safe environment for resident.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to deliver the complaint findings for the allegations listed above. LPA met with the Executive Director/Administrator Troy Byington and explained the reason for the visit.

The investigation into the allegation,resident was touched inappropriate by staff, revealed the following. It was alleged that while taking Resident 1’s (R1) temperature staff inappropriately touched R1. R1’s responsible party reported that they never witnessed any inappropriate behavior from staff and R1 never mentioned to them any staff acting inappropriately. The Administrator reported that R1 never reported any issues to him, and he never witnessed any staff touching R1 inappropriately. The Administrator reported that when R1 moved in they mentioned that they would prefer female caregivers, so the facility accommodated R1. The Administrator reported that most caregivers are female so there was no issue with providing this for R1. Three out three male staff interviewed reported they had no interactions with R1 and did not ever take R1’s temperature.

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: 11/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 4

Control Number 22-AS-20210505114545

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: 11/09/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

At the time the complaint was filed R1 did not respond to messages left by the LPA. R1 has since passed away. R1 was never interviewed. 5 out of 5 staff interviewed reported that they have never touched any resident inappropriately and had no knowledge of any staff touching R1 inappropriately. Based on the evidence gathered through a review of records and interviews the allegation, resident was touched inappropriate by staff is deemed unsubstantiated, although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur.

The investigation into the allegation, resident has fallen multiple times while in care, revealed the following. It was alleged that the resident fell multiple times while in care because the staff did not assist the resident. R1 was not interviewed at the time of the complaint because they did not respond to calls from the LPA investigating the complaint. R1 has since passed away and was never interviewed. 5 out of 5 staff interviewed stated that they had been informed that R1 was a fall risk and had been advised to use their walker and/or wheelchair but R1 did not always use them. 5 out of 5 staff interviewed reported that R1 was checked on regularly and informed to request assistance when transferring or needing any type of assistance. 5 out of 5 staff interviewed reported they had never seen R1 fall and were unaware of any recent falls by R1. R1’s responsible party reported that they knew R1 had multiple falls prior to moving into the facility but was unaware of any falls during 2021. 5 out of 5 staff interviewed reported that R1 has never reported any falls. The Administrator and Health Wellness Director reported that R1 has not suffered any falls recently. A review of special incident reports (SIRs) submitted to the Agency (Community Care Licensing) from the facility for the period of March 1, 2021, through June 30, 2021, showed that out of the 35 SIRs received there were no incidents with R1. Based on the evidence gathered through a review of records and interviews the allegation, resident has fallen multiple times while in care is deemed unsubstantiated, although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur.

The investigation into the allegation, staff are denying resident food revealed the following. 5 out of 5 staff interviewed reported that normally R1 went to the dining room on her own and did not request assistance when going to the dining room. 5 out of 5 staff interviewed reported that sometimes R1 requested that food be brought to her room, but they informed her that the facility only provided tray service free of charge during the Covid lockdown period in 2020. 2 out of 5 staff interviewed reported that on a few occasions they brought R1 meals to their room even though they were not on tray service.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 22-AS-20210505114545

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: 11/09/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

3 out of 5 staff interviewed reported asking R1 if they wanted anything to eat because they didn’t see R1 go to the dining room, but R1 declined. The Administrator and the Health and Wellness Director reported that they were unaware of any issues regarding R1 being denied food. R1’s responsible party reported on one occasion R1 had informed them that they had taken a nap and missed a meal, but they had told them the day after it took place. R1’s responsible party reported that other than that one instance R1 did not report to them that they were being denied food. R1 was not interviewed at the time of the complaint because they did not respond to calls from the LPA investigating the complaint. R1 has since passed away and was never interviewed. Based on the evidence gathered through interviews the allegation, staff are denying resident food, is deemed unsubstantiated, although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur.

The investigation into the allegation, staff are not checking on resident in a timely manner revealed the following. It was alleged that R1 would call the front desk of the facility, and no one would answer the phone and R1 would have to call 911 for assistance. R1 was not interviewed at the time of the complaint because they did not respond to calls from the LPA investigating the complaint. R1 has since passed away and was never interviewed. 5 out of 5 staff reported that when any resident calls for assistance using the facility call system they are assisted as quickly as possible. 5 out of 5 staff reported that they do not recall any instances when R1 had to wait more than 5 minutes for assistance when they used the facility call system. 2 out of 2 staff interviewed who answer the facility phone reported that the facility phone is always answered even at night and reported they are unaware of any instances when the phone is not answered. The Administrator and Health and Wellness Director reported that on a couple of occasions the fire department and police have showed up at the facility because R1 called them, but they left the facility and took no action because there was no need for their assistance. The Administrator reported that these incidents were not reported because none of the facility residents were in any danger, and no one was hurt in any way. Based on the evidence gathered through interviews the allegation is deemed unsubstantiated although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 22-AS-20210505114545

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: 11/09/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

5 out of 5 staff reported that they do not recall any instances when R1 had to wait more than 5 minutes for assistance when they used the facility call system. 2 out of 2 staff interviewed who answer the facility phone reported that the facility phone is always answered even at night and reported they are unaware of any instances when the phone is not answered. The Administrator and Health and Wellness Director reported that on a couple of occasions the fire department and police have showed up at the facility because R1 called them, but they left the facility and took no action because there was no need for their assistance. The Administrator reported that these incidents were not reported because none of the facility residents were in any danger, and no one was hurt in any way. Based on the information gathered the allegation, staff are not checking on resident in a timely manner, is deemed unsubstantiated, although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur.

The investigation into the allegation, staff are not providing a safe environment for resident, revealed the following. It was alleged that the facility does not have any doctors, dieticians, or nurses at the facility and that the Executive Director of the facility was going to cause harm to Resident 1 (R1). The Executive Director denied the claim and reported they would never harm or threaten any resident. The Executive Director reported that he was never contacted by the Police concerning this report. 3 out of 3 residents interviewed reported they have never been threatened or harmed by any staff members. 5 out of 5 staff interviewed reported they have never seen or heard any staff threaten or harm a resident. The facility is not required to have doctors, nurses, or dieticians at the facility as it is not a medical facility it is an assisted living facility. The facility does have a Licensed Vocational Nurse working at the facility. Based on the information provided the allegation, staff are not providing a safe environment for resident is deemed unsubstantiated, although the allegation may have happened or is 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: 11/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 4