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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306002915
Report Date: 02/09/2022
Date Signed: 02/09/2022 12:54:34 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
02/08/2022 and conducted by Evaluator Joseph Alejandre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20220208084306
FACILITY NAME:BROOKDALE ANAHEIMFACILITY NUMBER:
306002915
ADMINISTRATOR:TROY BYINGTONFACILITY TYPE:
740
ADDRESS:200 N DALE STTELEPHONE:
(714) 761-5771
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY:140CENSUS: 89DATE:
02/09/2022
UNANNOUNCEDTIME BEGAN:
10:13 AM
MET WITH:Mink Medina,TIME COMPLETED:
01:11 PM
ALLEGATION(S):
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9
Facility phone is in disrepair.
Staff are not providing adequate laundry service to residents.
Facility laundry machines are in disrepair.
Facility is not providing adequate transportation for residents.
Facility has no activities.

INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to begin the investigation into the allegations listed above. LPA was greeted and granted entry by staff. LPA met with Health and Wellness Director Mink Medina and explained the reason for the visit. The investigation revealed the following. LPA called the facility phone number and used the facility phone and verified it is working. Staff reported the phones are working and no residents have reported any phone related issues to them. Staff reported that laundry service is available and done weekly. While touring the facility LPA observed housekeeping cleaning rooms on the second floor and taking laundry from residents to be washed by the facility. LPA observed all washers and dryers are operating and available for use. Staff reported assistance with transportation is provided and available for residents. LPA observed resident activities being conducted during the visit (be fit exercise) which is on the activity schedule. .LPA obtained an activity schedule. Activity Director reported they conduct activities for the residents each day. Reporting Parties refused to corroborate any of the allegations and refused to be interviewed by LPA. Residents interviewed could not corroborate the allegations. Based on the information provided through observation and interviews, Continued on LIC 9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2022
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 3
Control Number 22-AS-20220208084306
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: 02/09/2022
NARRATIVE
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The preponderance of evidence standard has not been met based the evidence gathered, therefore the allegations, facility phone is in disrepair, staff are not providing adequate laundry service to residents, facility laundry machines are in disrepair, facility is not providing adequate transportation for residents, facility has no activities, are all 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.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3
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
02/08/2022 and conducted by Evaluator Joseph Alejandre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20220208084306

FACILITY NAME:BROOKDALE ANAHEIMFACILITY NUMBER:
306002915
ADMINISTRATOR:TROY BYINGTONFACILITY TYPE:
740
ADDRESS:200 N DALE STTELEPHONE:
(714) 761-5771
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY:140CENSUS: 90DATE:
02/09/2022
UNANNOUNCEDTIME BEGAN:
10:13 AM
MET WITH:Mink Medina, Eveline FabiolaTIME COMPLETED:
01:11 PM
ALLEGATION(S):
1
2
3
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5
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8
9
Resident is being charged late fees.
INVESTIGATION FINDINGS:
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The investigation into the allegation, resident is being charged late fees, revealed the following. LPA reviewed the account history report for Resident 1 (R1) and observed the late fees charged are always reversed right after being assessed. So the late charge does not effect R1's account balance. The reporting parties refused to be interviewed by the LPA and would not discuss anything with the LPA. LPA interviewed the Health and Wellness Director who stated they were aware of the late fee issue and explained that because of the dates involved in the charging of fees and payment of fees, the late fee and credit are required to balance the account. Based on the review of documentation and interviews the allegation, resident is being charged late fees, is deemed UNFOUNDED, meaning the allegation is false, could not have happened and/or is without a reasonable basis. An exit interview was conducted, and a copy of the report provided.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3