306002915-10-18-2024-22-AS-AORZ-DAE2EV-20241025172034

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306002915
Report Date: 10/18/2024
Date Signed: 10/18/2024 03:46:29 PM

Substantiated

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
10/14/2024 and conducted by Evaluator Sean Haddad

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20241014144704

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: 102	DATE:	10/18/2024
		UNANNOUNCED	TIME BEGAN:	12:20 PM
MET WITH:	Troy Byington		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff did not properly address resident's multiple falls at facility.

INVESTIGATION FINDINGS:

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This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of investigating the above-mentioned complaint allegation. LPA met with Administrator (AD) Troy Byington, discussed the purpose of the inspection, and explained the allegation.
The investigation into the allegation that staff did not properly address resident's multiple falls at facility revealed the following: During the course of the investigation, LPA inspected the facility, interviewed AD, Health and Wellness Director (HWD) Mink Medina, and witnesses, and obtained and reviewed copies of the resident roster, staff roster, Resident #1’s (R1) Physician’s Report dated May 31, 2024, Facility Incident Reports for R1 dated September 1, 2024, to October 13, 2024, and R1’s Personal Service Plan dated October 13, 2024.
It was alleged that R1 was taken to the hospital on October 10, 2024, after sustaining a fall at the facility and was diagnosed with a potential wrist fracture, this is not the first time R1 was taken to the hospital due to a fall at the facility, and R1 suffers from frequent falls at the facility.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2024

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-20241014144704

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: 10/18/2024

NARRATIVE

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LPA interviewed AD who stated that R1 is no longer a resident of the facility, could not walk due to having both of their feet amputated, had dementia, resided in the memory care unit, and was on hospice. LPA reviewed R1’s Physician’s Report dated May 31, 2024, which indicates R1 has dementia and is non-ambulatory. LPA inspected the memory care unit where R1 resided, conducted health and safety checks on the residents, and observed no health and safety issues. LPA inspected R1’s former room and observed no health and safety issues. Per AD, R1 had a fall on March 10, 2024, and then eight falls between September 1, 2024, and October 13, 2024, none of which resulted in fractures but did result in stitches and bandages, and were caused by R1 trying to get up and walk forgetting that they could not walk without a walker. LPA reviewed Facility Incident Reports for R1 dated September 1, 2024, to October 13, 2024, which document the eight falls that R1 suffered during this period. AD and HWD stated in interviews that after the March 10, 2024 fall, the facility began conducting regular safety checks on R1 and lowered R1’s bed to the lowest position and R1 did not have any falls for a few months afterwards. Per AD and HWD, after the series of eight falls began on September 1, 2024, the facility took the following steps to address R1’s falls: staff had multiple conversations with R1’s family to address R1’s falls; a fall pad was paced in front of R1’s bed; R1 was encouraged to spend time in the activity room where they would be under closer observation and would not try to get up; a halo was requested from hospice for R1’s bed, which was refused by hospice; hospice suggested a full bed rail, but the facility’s policy is for no restraints to keep residents in bed; R1’s medications were adjusted multiple times to address their agitation which contributed to their falls; one-on-one supervision was suggested to R1’s family, which was refused; volunteers and continuous care were requested from hospice, which were refused. LPA reviewed R1’s Personal Service Plan dated October 13, 2024, which, per AD, documents the facility’s fall prevention plan, and noted that the fall prevention plan does not include one-on-one supervision and that approximately twenty-two falls for R1 were documented in 2024. Per AD, only nine of these falls required a visit to the hospital. When asked why the facility did not provide one-on-one supervision to address R1’s eight falls in a little over a month, AD stated that R1’s family refused. LPA interviewed one witness who stated that the facility did not offer or suggest one-on-one supervision to R1’s family, the facility waited too long to administer R1’s psychiatric as-needed medications, resulting in R1 getting too agitated and refusing the medications, which contributed to R1’s falls, and that R1’s multiple falls resulted in lacerations, pain, and sometimes stitches. The measures taken by the facility to address R1’s falls clearly did not work and therefore the facility did not provide care and supervision to meet R1’s needs. The information obtained corroborated the allegation.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2024

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20241014144704

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: 10/18/2024

NARRATIVE

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During the course of the investigation, the Department obtained sufficient evidence to substantiate the allegation mentioned above. The preponderance of evidence standard has been met; therefore, the above allegation is Substantiated. See LIC9099D for cited deficiencies per Title 22 Division 6 of the California Code of Regulations. Civil penalties for repeat violations are being assessed. See LIC421FC. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2024

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20241014144704

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/18/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 10/19/2024 Section Cited CCR 87464(f)(1)	1 2 3 4 5 6 7	87464 Basic Services (f) Basic services shall at a minimum include: (1) Care and supervision… This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee stated they will create fall prevention policy and train supervisory staff on the policy and submit proof to LPA by POC due date. CIVIL PENALTY ASSESSED.
	8 9 10 11 12 13 14	Based on interviews and documents, the licensee did not ensure R1 received care and supervision to meet their needs in light of their fall risk and approximately twenty-two falls in one year, which poses an immediate safety risk to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2024

LIC9099 (FAS) - (06/04)

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