306002954-10-13-2023-22-AS-AORZ-CXJQTQ-20231113112730

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306002954
Report Date: 10/13/2023
Date Signed: 10/13/2023 03:21:02 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
07/26/2023 and conducted by Evaluator Celine DePerio

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230726101433

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:	10/13/2023
		UNANNOUNCED	TIME BEGAN:	01:57 PM
MET WITH:	Executive Director- Shannon Howell		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Staff did not give proper notice to resident's designated representative of rate increases.
Staff did not give resident's designated representative explanations for rate increases.
Staff incorrectly billed resident for medications.
Staff are not following resident's medication doctor's orders.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Celine De Perio conducted an unannounced visit to the facility to deliver the findings. LPA De Perio explained the purpose of today's visit, was greeted by Executive Director (ED) Shannon Howell.

It was alleged that staff did not give proper notice to resident's designated representative of rate increases. LPA conducted an interview with the reporting party (RP) who stated that the current ED explained everything to RP regarding rate increases, of which RP also verified that the notice was received and provided timely.

It was alleged that staff did not give resident's designated representative explanations for rate increases. LPA conducted an interview with RP and staff 1 (S1), of which both interviews verified that explanations were provided regarding the increases. Both interviews stated that resident 1 (R1) would order "tray service" to their room and was getting charged every time R1 utilized tray service.

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: 10/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023

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-20230726101433

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: 10/13/2023

NARRATIVE

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1 of the interviews specified that prior management failed to charge R1 for tray services, and now that there is new management at the facility, the management is adhering to the protocol regarding the rate increases. RP also stated that R1 was notified about these increases due to the tray services, to which R1 was provided explanations and encouragement to not utilize tray services if R1 did not want to continue paying. LPA reviewed records and it was observed that prior management did not charge R1 for tray services and obtained verification from R1 that R1 had been utilizing tray services "all the time".

It was alleged that staff incorrectly billed resident for medications. LPA conducted an interview with RP and S1 and it was revealed that R1 is being charged for a prescribed medication, however RP believes that R1 does not need it, therefore it should not be billed. The interview with S1 stated that the facility contacted R1's doctor to inquire about if R1's medication should be discontinued, to which the doctor declined and stated that the medication for R1 would be continued as needed. LPA reviewed records and it was observed that the medication chart for R1 is up to date and reflect the medications that are prescribed by the doctor.

It was alleged that staff are not following resident's medication doctor's orders. An interview with S1 stated that RP believes what medications R1 should not have, however, S1 verified that the facility manages R1's medications. The medication RP believes should be discontinued is a pro re nata "PRN" of which S1 stated that the PRN medication is only given to R1 as needed per physician report. An interview was conducted with RP, who was unable to provide further information regarding this allegation. RP then requested LPA to "disregard" the allegations/complaint due to obtaining information and explanations from the facility.

Based on LPA’s interviews which were conducted, review of documents obtained, and observations, LPA is unable to ascertain if the allegations occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, the allegations are deemed UNSUBSTANTIATED.

An exit interview was conducted with ED Howell. A copy of this report was explained and provided.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerio	TELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023

LIC9099 (FAS) - (06/04)

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