306002915-9-22-2022-22-AS-LADS-CJS4HB-20220930190653

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306002915
Report Date: 09/22/2022
Date Signed: 09/22/2022 10:41:45 AM

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
05/09/2022 and conducted by Evaluator Albert Marin

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20220509141641

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: 104	DATE:	09/22/2022
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Executive Director Troy Byington		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Staff did not bring changes in resident's condition to the attention of responsible person.
Staff did not provide resident assistance with showering as needed.
Staff did not provide resident assistance with dressing as needed.
Staff did not provide resident assistance with clean linens as needed.
Facility did not provide an itemized statement that lists all separate charges incurred by the resident.
Facility did not answer communications to the authorized representative promptly or appropriately.
Facility had no enough staff to meet residents' needs.
Facility did not assist resident in receiving phone calls.
Facility did not provide authorized representative with proper notification of rate increases.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Albert Marin made an unannounced visit in the facility to deliver the final report for the investigation completed for the complaint file last May 9, 2022 against the facility. LPA met with Executive Director (ED) Troy Byington, stated the purpose of the visit, and discussed the following findings.

On allegation that staff did not bring changes in resident's condition to the attention of responsible person, the following are the findings. It was reported that on February 2022, Resident 1 was pulled out anti-depressant medication. R1 was observed to be withdrawn. Per interviews, these changes had been communicating to resident’s physician and offered no concerns on how the facility communicated the changes. With random interviews, four out of six witnesses stated that facility communicated the changes observed with their respective residents. LPA is unable to ascertain if the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed UNSUBSTANTIATED.
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Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Albert Marin	TELEPHONE: (714) 309-7843
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022

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-20220509141641

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: 09/22/2022

NARRATIVE

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On allegation that staff did not provide resident assistance with showering as needed, the following are the findings. Based on observation during the initial visit completed last May 18, 2022, LPAs observed that the residents in memory care appeared well groomed. Based on interviews, four out of six witnesses interviewed stated that the staff aided with showering needs of the residents. Thus, the above allegation is UNSUBSTANTIATED.

On allegation that staff did not provide resident assistance with dressing as needed, the following are the findings. Based on observation during the initial visit completed last May 18, 2022, LPAs observed that the residents in memory care appeared dressed appropriately for the weather and occasion. Based on interviews, four out of six witnesses interviewed stated that the staff aided with dressing needs of the residents. Thus, the above allegation is UNSUBSTANTIATED.

On allegation that staff did not provide resident assistance with clean linens as needed, the following are the findings. Based on interviews, six out of seven witnesses interviewed stated that the staff provided resident assistance with clean linens. Thus, the above allegation is UNSUBSTANTIATED.

On allegation that licensee did not answer communications to the authorized representative promptly or appropriately, the following are the findings. It was reported that a responsible party was seeking out clarification on the statements received. Per interviews and file review, R1 was determined to need services in the memory care. Prior to move in, facility held a care assessment meeting with responsible party. Both parties agreed to move R1 to memory care. Thus, the above allegation is deemed UNSUBSTANTIATED.

On allegation that facility did not provide an itemized statement that lists all separate charges incurred by the resident, the following are the findings. It was reported that the responsible party was seeking clarification on the itemized statement. Per interview and file review, prior to move in of R1 to memory care, additional charges had been discussed during the care assessment meeting prior to the move in. Copies of these new charges were sent via certified mail to the responsible party. Thus, the above allegation is deemed UNSUBSTANTIATED.

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SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Albert Marin	TELEPHONE: (714) 309-7843
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 22-AS-20220509141641

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: 09/22/2022

NARRATIVE

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On allegation that facility had no enough staff to meet residents' needs, the following are the findings. It was reported that on April 30, 2022, it was observed that there was only one staff member in memory care. Based interviews, four out of eight witnesses interviewed stated that the staffing was good. One witness stated that sometimes the facility was short staffed. three out of eight witnesses stated facility was short staffed. Thus, the above allegation is UNSUBSTANTIATED.

On allegation that facility did not assist resident in receiving phone calls. It was reported that callers for R1 could not get hold of the resident. Based on observation, during the initial visit completed on May 18, 2022, LPAs Marin and De Perio called the facility landline (714) 761-5771 and asked to speak to a resident. Staff assisted the resident to receive the call. Thus, the allegation is UNSUBSTANTIATED.

Facility did not provide authorized representative with proper notification of rate increases, the following are the findings. Per interviews and file review, R1 was determined to need services in the memory care. Prior to move in, facility held a care assessment meeting with responsible party. In the meeting facility presented the rate increases that would be applied when R1 moves to memory care. Both parties agreed to move R1 to memory care. Thus, the above allegation is deemed UNSUBSTANTIATED.

LPA Marin conducted an exit interview with ED Byington and copy of this report was left in the facility.

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SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Albert Marin	TELEPHONE: (714) 309-7843
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022

LIC9099 (FAS) - (06/04)

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