306002915-6-7-2024-22-AS-LMOA-D7E6CG-20240721204129

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306002915
Report Date: 06/07/2024
Date Signed: 06/07/2024 12:50:01 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
06/04/2024 and conducted by Evaluator Jessica Cho

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20240604145438

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: 110	DATE:	06/07/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Troy Byington- Executive Director		TIME COMPLETED:	01:10 PM

ALLEGATION(S):

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Staff stole resident's medication.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jessica Cho arrived at the facility unannounced for the purpose of initiating the 10-day complaint investigation into the above allegation. LPA met with Executive Director (ED) Troy Byington and stated the purpose of the visit. During the course of the investigation, LPA interviewed one resident and five staff and pertinent documentation were obtained which includes: Resident Roster, Personnel Report Summary with staff's contact information, Face Sheet, Physician's Report, Medication List, Report of Suspected Dependendent Elder Abuse (SOC341), Photographs pertaining to Resident #1 (R1), and additional records pertaining to Staff #1 (S1). The investigation revealed the following:

Regarding the allegation, Staff stole the resident's medication, it was alleged that on Thursday, May 30, 2024, S1 stole R1's opioid tablets, Hydrocodone-Acetaminophen. Per review of the Physician's Report dated April 12, 2024, R1 self-administers and stores their own medications.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lourdes Montoya	TELEPHONE: (714) -70-2870
LICENSING EVALUATOR NAME: Jessica Cho	TELEPHONE: 714-703-2853
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2024

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-20240604145438

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: BROOKDALE ANAHEIM	FACILITY NUMBER: 306002915
	VISIT DATE: 06/07/2024

NARRATIVE

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It was confirmed during the interviews with two out of the two staff that R1 stores the medications inside the pink lock box placed next to their recliner. R1 did not have a lock for the lockbox as the room is a for a single occupant. Four out of the five staff and one out of the one resident interviewed stated that they did not observe S1 stealing the medication. However, a witness staff indicated that S1 was observed to be on the second floor heading towards the direction of R1's room. S1 denied the allegation stating that they did not assist R1 in their bedroom on May 30th. LPA observed there were no surveillance cameras on the second floor.

Therefore, based on the interviews which were conducted and the records that were reviewed, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the following allegation: Staff stole the resident's medication is deemed UNSUBSTANTIATED.

An exit interview was conducted with Executive Director Troy Byington, and a copy of this report including the LIC811s were provided at the end of the visit.

SUPERVISOR'S NAME: Lourdes Montoya	TELEPHONE: (714) -70-2870
LICENSING EVALUATOR NAME: Jessica Cho	TELEPHONE: 714-703-2853
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2024

LIC9099 (FAS) - (06/04)

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