306002915-2-7-2025-22-AS-AORZ-DFJU3W-20250408151410

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306002915
Report Date: 02/07/2025
Date Signed: 02/07/2025 04:28:23 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
01/29/2025 and conducted by Evaluator Andrea Mendivil

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20250129104320

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: 98	DATE:	02/07/2025
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Troy Byington- Executive Director		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Staff do not give resident privacy to get dressed
Staff do not ensure that resident's hygiene needs are met
Staff do not ensure that resident is accorded dignity in their relationship with staff or other persons

INVESTIGATION FINDINGS:

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On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to conduct a complaint investigation. LPA was greeted and granted entry into the facilty by Troy Byington, Executive Director and explained the reason for the visit.

The Department received a complaint on 01/29/2025 and LPA Mendivil conducted the initial 10 day visit on 02/07/2025. During the visit LPA Mendivil obtained copies of staff schedule and housekeeping assignments as well as interviewed staff and residents. Regarding the allegations staff did not give resident privacy to get dressed, staff do not ensure that resident's hygiene needs are met, and staff do not ensure that resident is accorded dignity in their relationship with staff or other persons, the investigation revealed the following:

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-4084
LICENSING EVALUATOR NAME: Andrea Mendivil	TELEPHONE: 714-703-2738
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2025

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-20250129104320

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: 02/07/2025

NARRATIVE

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It was alleged that facility staff entered the rooms of residents while they were getting dressed or disrobed. 5 out of 5 staff stated they did not enter any resident's room while they were getting dressed or disrobed. Staff all reported they knock on resident's rooms prior to entering. 6 out of 6 residents stated staff has not entered their rooms without permission and not while they were dressing.

Regarding allegation staff do not ensure residents hygiene needs are met, 3 out of 5 residents stated they have not had any issues with staff assisting with showers and other hygiene needs or heard of any issues. The 2 other residents did not have direct knowledge as they do not need assistance with hygiene. 5 out of 5 staff deny they are not meeting resident's hygiene needs,

Regarding the allegation staff do not ensure that resident is accorded dignity in their relationship with staff or other persons, 6 out of 6 residents stated they are treated with respect and dignity by all the staff at the facility. 6 out of 6 residents stated they no complaints about any of the staff. 5 out of 5 staff deny the allegation.

Therefore based on records reviewed, interviews and observations the allegations staff do not give residents privacy to get dressed, staff do not ensure that residents hygiene needs are being met and staff do not ensure that residents are accorded dignity in their relations with staff or other persons are determined to be UNSUBSTANTIATED, meaning 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.

An exit interview was conducted and a copy of the report provided.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-4084
LICENSING EVALUATOR NAME: Andrea Mendivil	TELEPHONE: 714-703-2738
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2025

LIC9099 (FAS) - (06/04)

Page: 4 of 4

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
01/29/2025 and conducted by Evaluator Andrea Mendivil

COMPLAINT CONTROL NUMBER: 22-AS-20250129104320

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: 98	DATE:	02/07/2025
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Troy Byington- Executive Director		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Staff did not keep the facility clean and sanitary

INVESTIGATION FINDINGS:

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On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to conduct a complaint investigation. LPA was greeted and granted entry into the facilty by Troy Byington, Executive Director and explained the reason for the visit.

The Department received a complaint on 01/29/2025 and LPA Mendivil conducted the initial 10 day visit on 02/07/2025. During the visit LPA Mendivil obtained copies of staff schedule and housekeeping assignments as well as interviewed staff and residents. Regarding the allegation staff did not keep the facilty clean and sanitary, the investigation revealed the following:

For the allegation staff did not keep facility clean and sanitary, 6 out of 6 residents stated the facility is clean and sanitary. 6 out of 6 residents stated the housekeeping staff does a great job. Per LPA Mendivil's observations on 2 seperate visits the facility is clean and does not have any malodorous smells. 5 out of 5 staff stated the facility is maintained by all staff.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-4084
LICENSING EVALUATOR NAME: Andrea Mendivil	TELEPHONE: 714-703-2738
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2025

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 4

Control Number 22-AS-20250129104320

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: 02/07/2025

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	Therefore based on the preponderance of evidence through observations and interviews the allegation that Staff did not keep the facility clean and sanitary is determined to be UNFOUNDED, meaning that the allegations were false, could not have happened and/or is without a reasonable basis. No deficiencies cited. An exit interview was conducted and a copy of this report was provided.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-4084
LICENSING EVALUATOR NAME: Andrea Mendivil	TELEPHONE: 714-703-2738
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 4