306002954-3-16-2023-22-AS-LADS-CPZVB7-20230317161703

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306002954
Report Date: 03/16/2023
Date Signed: 03/16/2023 12:27:12 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
02/17/2023 and conducted by Evaluator Celine DePerio

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230217165102

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: 80	DATE:	03/16/2023
		UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	West Division Operations Specialist /Executive Director (ED) - Lilit Mnatsakanyan		TIME COMPLETED:	12:05 PM

ALLEGATION(S):

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Facility staff are not properly trained.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Celine De Perio made an unannounced visit to the facility to deliver the findings for the complaint recieved on 2/17/23. 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 80 residents in care of which 2 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: 03/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2023

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-20230217165102

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: 03/16/2023

NARRATIVE

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The Department has investigated the complaint alleging that facility staff are not properly trained. LPA conducted record reviews included but not limited to: the facility handbook, job descriptions (specifically for the receptionist and kitchen server) resident roster, staff roster (LIC500), staff trainings, front desk duties and front desk “template” which included “front desk FAQs” such as inquiries regarding: Bingo, move-ins, move-outs, emails and communication log, walkie-talkies, packages, emergency binders, maintenance work orders, human resources and payroll, laundry and trash, billing and invoices, pharmacy and doctors, sales and marketing. In addition, a concierge shift checklist is completed and provided, and a concierge shift log.

LPA conducted a total of 10 interviews of which consisted of staff and residents, of which none of the interviews corroborated with the allegation. 10 out of the 10 interviews either stated that staff were “knowledgeable” and “well trained”, while the interviews conducted with staff verified that training is provided for all positions, and even if a staff member is asked to assist with a task other than their designated position, training is provided via “shadowing”.

LPA reviewed the job descriptions for the receptionist and kitchen server positions and both positions had the same education and experience requirements, certification requirements, management, decision making, and knowledge and skills.

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.

For today's visit, no citations were issued.

An exit interview was conducted with ED Mnatsakanyan 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: 03/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2023

LIC9099 (FAS) - (06/04)

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