306002915-1-22-2025-22-AS-AORZ-DDEM8N-20250130082324

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306002915
Report Date: 01/22/2025
Date Signed: 01/22/2025 03:01:24 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
06/15/2023 and conducted by Evaluator Kimberly Lyman

COMPLAINT CONTROL NUMBER: 22-AS-20230615102458

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:	01/22/2025
		UNANNOUNCED	TIME BEGAN:	10:40 AM
MET WITH:	Troy Byington		TIME COMPLETED:	03:25 PM

ALLEGATION(S):

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Staff do not ensure bathrooms are kept in clean, safe, sanitary conditions
Facility bathroom floor is in disrepair
Staff do not respond to signal system for residents timely manner

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to continue the investigation into the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit.
During the course of the investigation, LPA toured the facility and interviewed residents and staff as well as reviewed and obtained pertinent documentation such as extermination records. Regarding the allegations that staff do not respond to signal system for residents in a timely manner, facility bathroom floor is in disrepair, and staff do not ensure bathrooms are kept in clean, safe, sanitary conditions, the investigation revealed the following: Facility expectations for call button response times is 10-15 minutes. Four out of four staff and six out of seven residents state staff usually respond within those parameters. Seven out of seven residents state their needs are being met by facility staff. Facility does not have documentation of response times however staff state the pager goes off every five mintes until the call system is reset. Facility indicates using Ecolab Pest for monthly extermination services. LPA reviewed documentation from 01/2023-07/2023 indicating CONTINUED ON LIC 9099C DATED 01/22/2024

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly Lyman	TELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025

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-20230615102458

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: 01/22/2025

NARRATIVE

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monthly service. Documentation stated no cockroach activity noted during treatment. LPA did not observe any cockroach activity during the visit. LPA observed three common restrooms during the visit, two located near the Administrator office and one in the Wellness office. All three restrooms are clean and sanitary with no health concerns noted. LPA did not observe any issues with the flooring or vents. Facility staff indicate restrooms are as they were in 2023 and no repairs have been done in that time frame. Based on interviews conducted and record review, LPA is unable to corroborate the allegations. Therefore the allegations are deemed to be UNSUBSTANTIATED, meaning that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred.

Exit interview conducted and a copy of this report was left at the facility.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly Lyman	TELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025

LIC9099 (FAS) - (06/04)

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