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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306002954
Report Date: 11/19/2021
Date Signed: 11/19/2021 12:18:43 PM

Unfounded


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
11/03/2021 and conducted by Evaluator Michelle Reed
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20211103101156
FACILITY NAME:BROOKDALE IRVINEFACILITY NUMBER:
306002954
ADMINISTRATOR:CARRIE GALLOWAYFACILITY TYPE:
740
ADDRESS:10 MARQUETTETELEPHONE:
(949) 854-3766
CITY:IRVINESTATE: CAZIP CODE:
92612
CAPACITY:155CENSUS: 117DATE:
11/19/2021
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Administrator Carrie GallowayTIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
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5
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7
8
9
Illegal Eviction
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA), Michelle Reed made an unannounced visit to the facility for the purpose of presenting the findings of the complaint investigation. Upon arrival, LPA met with Administrator Carrie Galloway. The investigation consisted of interviews with the facility staff, Administrator Carrie Galloway, and witnesses as well as documentation. The following was determined: Resident #1 (R1) was admitted into Brookdale Irvine on 11/24/20. At the time of admission R1 was bedridden and needed assistance with her ADL's. Staff were to use a hoyer lift to help transfer R1 due to lower extremity weakness. R1 did not want to use the hoyer lift for fear of falling and would often refuse physical therapy. R1 was a 2 person assist and then became a 3 person assist. On 10/14/21 R1's doctor provided notice in writing that R1 needed a higher level of care due to neuropathy. Brookdale issued a 30 day eviction notice on 10/20/21. Based upon Interviews and information obtained during the investigation the allegation is unfounded meaning the allegation was false, could not have happened and/or is without a reasonable basis. This agency has investigated this complaint and no deficiencies are being cited. The eviction is legal based upon R1 needing a higher level of care. An exit interview was conducted and copy of this report was provided to Administrator Galloway.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: Michelle ReedTELEPHONE: (714) 743-4958
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2021
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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