306002954-3-3-2023-22-AS-LADS-CPPS9W-20230307124121

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306002954
Report Date: 03/03/2023
Date Signed: 03/03/2023 01:16:15 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
02/21/2023 and conducted by Evaluator Celine DePerio

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230221120641

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: 82	DATE:	03/03/2023
		UNANNOUNCED	TIME BEGAN:	09:07 AM
MET WITH:	West Division Operations Specialist/Executive Director (ED) - Lilit Mnatsakanyan		TIME COMPLETED:	01:37 PM

ALLEGATION(S):

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Residents are not being accorded with dignity and respect.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Celine De Perio made an unannounced complaint visit to the facility to initiate the 10-day visit for the complaint received on 2/21/23 and to deliver the findings. LPA De Perio was greeted by West Division Operations Specialist who is also acting as Executive Director (ED) Lilit Mnatsakanyan and stated the purpose of the visit.

For today's visit, there are a total of 82 residents in care of which 3 are on hospice. LPA De Perio conducted interviews with staff and residents, and reviewed and requested copies of the pertinent records.

This department has investigated the complaint alleging that residents are not being accorded with dignity and respect.

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: 03/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2023

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-20230221120641

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: 03/03/2023

NARRATIVE

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LPA conducted a total of 10 interviews, which consisted of staff and residents. 10 out of the 10 interviews conducted did corroborate with the allegation.

LPA conducted an interview with the facility resident council of which was reported that staff (S1) who is indicated in the allegation, is "great" and it was a "no brainer to nominate S1 as employee of the month", S1 is "efficient", "can do it all", and added that "sometimes these residents can have lots of demands, but she always keep her composure and is respectful and has never been anywhere near being disrespectful".

LPA conducted an interview with the resident (R1) in the allegation who stated "every single worker here, I have no complaints about, and no issues". R1 also stated "the food and service is good, no bad attitudes, they are always friendly"

LPA conducted an interview with S1 who stated "If I have things happening in my personal life, with stress and things that make me cry, I make sure I don't bring it here" S1 added "This is my dream job, I would not do anything to mess it up. I don't come from much, so having this job is everything to me"

LPA reviewed the following documents but not limited to the: staff roster, resident roster, facility policies, dining and kitchen staff schedules, facility dining menu, dining and kitchen staff job description, roles and responsibilities, staff trainings, resident council notes, and physician report for R1.

Based on the information gathered during the investigation and review of documents obtained, 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.

LPAs conducted an exit interview was ED 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: 03/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2023

LIC9099 (FAS) - (06/04)

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