306002954-1-23-2023-22-AS-LADS-CNFMUR-20230126085534

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306002954
Report Date: 01/23/2023
Date Signed: 01/23/2023 03:50:24 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
11/15/2022 and conducted by Evaluator Celine DePerio

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20221115104657

FACILITY NAME:	BROOKDALE IRVINE		FACILITY NUMBER:	306002954
ADMINISTRATOR:	CARRIE GALLOWAY		FACILITY TYPE:	740
ADDRESS:	10 MARQUETTE		TELEPHONE:	(949) 854-3766
CITY:	IRVINE	STATE: CA	ZIP CODE:	92612
CAPACITY:	155	CENSUS: 84	DATE:	01/23/2023
		UNANNOUNCED	TIME BEGAN:	02:47 PM
MET WITH:	Operations Specialist/Executive Director-Lilit Mnatsakanyan		TIME COMPLETED:	04:05 PM

ALLEGATION(S):

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Facility does not have adequate staffing to meet resident's needs.
Staff does not provide adequate food service to residents in care.
Facility does not have an administrator during operation hours.
Facility is in disrepair.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Celine De Perio made an unannounced visit to this facility. LPA De Perio met with Operations Specialist/Executive Director-Lilit Mnatsakanyan and stated the purpose of this visit, which was to deliver the final findings for the complaint received on 11/15/22 against this facility.

For today's visit, there are a total of 84 residents in care of which 4 residents are on hospice.

See LIC9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerio	TELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2023

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-20221115104657

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 IRVINE	FACILITY NUMBER: 306002954
	VISIT DATE: 01/23/2023

NARRATIVE

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This agency has investigated the allegation that the facility does not have adequate staffing to meet resident's needs. LPA De Perio conducted interviews and file reviews of which interviews conducted either stated that since the facility was turned over to new management, the facility now does have enough staff, or it was stated that the only area of the facility where there was not enough staff was in the dining room. LPA reviewed staff schedules and staff availability for both day and night shifts, and it was observed that facility did have sufficient amount of staff to assist with coverage and additional tasks. Based on observations, interviews and record reviews, 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.

This agency has investigated the allegation that staff does not provide adequate food service to residents in care. LPA De Perio conducted file reviews and interviews, and the interviews conducted stated that since the Dining Director at facility resigned, the dining area has been short-staffed. However, per record reviews and interviews, it was stated and observed that management has been working extra shifts in the dining area to ensure coverage. Based on the information gathered during the investigation and review of documents obtained, LPA observed that despite facility being short-staffed in the dining hall, facility did have an adequate amount of staff who assisted with coverage and tasks in the dining hall. 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.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerio	TELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2023

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20221115104657

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 IRVINE	FACILITY NUMBER: 306002954
	VISIT DATE: 01/23/2023

NARRATIVE

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This agency has investigated the allegation that facility does not have an administrator during operating hours. The Reporting Party stated that the administrator that the allegation is referring to is the previous administrator and not the current administrator present in facility (as of September 2022 to January 2023). LPA De Perio interviewed a total of 7 individuals, of which 1 of the 7 declined wanting to be interviewed. Per the interviews conducted, it was stated that the previous administrator “didn’t do anything” “was never present” and “never showed her face”. Based on observations, interviews and record reviews, 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.

This agency has investigated the allegation that the facility is in disrepair. LPA De Perio was notified that upon facility elevator breaking, the facility contacted an elevator repair company in no more than 24 hours requesting for a repair. However, due to the elevator company being backlogged, the facility did not receive repair services right away. LPA De Perio also observed that the facility had an alternate elevator for individuals to utilize and that there was only 1 elevator in the entire facility that needed maintenance. Based on observations, interviews and record reviews, 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.

For today’s visit, no deficiencies were issued and citations were issued per Title 22 Division 6 of the California Code of Regulations.

An exit interview was conducted with Operations Specialist/Executive Director-Lilit Mnatsakanyan, and a copy of this report was provided to the facility.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerio	TELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2023

LIC9099 (FAS) - (06/04)

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