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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002915
Report Date: 10/26/2022
Date Signed: 10/26/2022 12:48:59 PM


Document Has Been Signed on 10/26/2022 12:48 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:BROOKDALE ANAHEIMFACILITY NUMBER:
306002915
ADMINISTRATOR:TROY BYINGTONFACILITY TYPE:
740
ADDRESS:200 N DALE STTELEPHONE:
(714) 761-5771
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY:140CENSUS: 101DATE:
10/26/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Troy ByingtonTIME COMPLETED:
01:00 PM
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This unannounced case management inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of following up on a self-reported incident report received in the Orange County Regional Office (OCRO) on 10/14/22 regarding Resident #1 (R1) and Staff #1 (S1). LPA met with Administrator (AD) Troy Byington and explained the purpose of the inspection.

The incident report states the following: On 10/11/22, R1’s family notified the facility of suspicious charges on R1’s bank account and mentioned the name of S1 who is an employee of the facility. On 10/12/22, R1’s family provided copies of bank statements to the facility showing 5 suspicious transactions totaling $1,185.02. On 10/12/22, the facility reported the incident to LPA, the OCRO, the Long-Term Care Ombudsman, and the Anaheim Police Department.

During today’s inspection, LPA requested and reviewed copies of R1’s bank records, R1’s resident file, and S1’s staff file. LPA conducted a health and safety check on R1, observed no health and safety issues, and interviewed R1. S1 was not present at the facility. LPA interviewed AD who provided the following information: S1 was suspended on 10/11/22. As part of the facility’s investigation, AD interviewed S1 on 10/12/22 and S1 admitted to engaging in the fraudulent charges on R1’s bank account, apologized and stated they needed the money and were having financial difficulties, and offered to pay the money back to R1. S1’s employment was terminated on 10/13/22. The Anaheim Police Department came to the facility on 10/14/22 to obtain information from AD and are referring the case to another local police department based on S1’s residence location. AD stated that it is unknown the method(s) S1 used to engage in the fraudulent transactions. Review of R1’s bank records revealed that S1’s name is specified in some of the transactions identified by R1’s family as being suspicious, some of which are simple money transfers from R1 to S1.

Facility representative was advised that at this time further investigation may be required. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:
DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/26/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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