306002954-9-11-2023-22-AS-AORZ-CW5PKX-20230929112352

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306002954
Report Date: 09/11/2023
Date Signed: 09/11/2023 03:31:27 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
07/24/2023 and conducted by Evaluator Alvaro Ramirez Jr.

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230724102229

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: 77	DATE:	09/11/2023
		UNANNOUNCED	TIME BEGAN:	01:06 PM
MET WITH:	Shannon Howell-Executive Director		TIME COMPLETED:	03:11 PM

ALLEGATION(S):

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Facility has pests.
Staff failed to provide adequate food service.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced complaint visit to deliver findings on the above allegations received on 07/24/23. LPA was greeted and granted entry into the facility and met with Executive Director (ED) Shannon Howell. LPA explained the reason for the visit.

On today’s visit LPA Ramirez conducted file reviews and interviews and obtained copies of pertinent documents. Regarding the allegation that facility has pests, the following was revealed: Seven of eight individuals interviewed denied the allegation. The remaining individual reported seen a rat in the the lounge area during mid-July. During the course of the investigation LPA reviewed documents including the Ecolab Service Inspection Reports for June and July 2023. Two of two Ecolab Service Reports state the following: "Inspected and treated selected areas. Pest Activity Found." During the initial visit on 07/26/23 LPA toured the kitchen and observed rat traps on the corners of the kitchen floor.

CONTINUED ON 9099-C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2023

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-20230724102229

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: BROOKDALE IRVINE	FACILITY NUMBER: 306002954
	VISIT DATE: 09/11/2023

NARRATIVE

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It was reported via interviews by Staff 1 (S1) that the rat traps were placed in the kitchen by the Pest Control company for pest prevention. During the interviews with residents it was reported that they have never seen a rat, a mouse and/or rodents in the facility.

Regarding the allegation that staff failed to provide adequate food service, the investigation revealed the following: Four of five residents interviewed denied the allegation. Per interviews conducted with residents it was reported that the facility provides residents with warm quality food and/or enough food. Per interviews conducted with residents it was reported that the food can be cold sometimes. It was reported via interviews with staff that staff have not failed to provide hot food and/or provide adequate food for the residents.

Based on LPA's observation and information gathered during the investigation, LPA is unable to ascertain if the allegation occurred as reported due to conflicting information. 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, the allegations are deemed UNSUBSTANTIATED.

LPA Ramirez conducted an exit interview with ED Howell and a copy of this report was provided to the facility.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2023

LIC9099 (FAS) - (06/04)

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