306002954-1-15-2025-22-AS-LMOA-DDFTRQ-20250131135751

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306002954
Report Date: 01/15/2025
Date Signed: 01/15/2025 01:59:45 PM

Unfounded

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
01/09/2025 and conducted by Evaluator Lydia Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20250109160520

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: 132	DATE:	01/15/2025
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Sharin Belanger		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Facility failed to provide reasonable accommodation to a resident's needs & preferences

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Lydia Martinez made an unannounced visit to the facility to initiate a 10-Day complaint investigation into the above allegation. LPA met with Business Office Manager Sharin Belanger. LPA spoke to Executive Director (ED) Shannon Howell via telephone.

LPA conducted a walk-through of the facility, obtained copies of the Staff schedule and Resident roster and other pertinent documents. LPA also conducted interviews with the Executive Director via telephone, Business Office Manager, Health & Wellness Director, 2 staff and 13 residents. Regarding allegation that Facility failed to provide reasonable accommodation to a resident's needs & preferences, the investigation revealed the following: On 07/28/2024, Resident 1 (R1) was intoxicated and had a fall hitting R1's head. On 07/30/2024, facility received a doctor's order for R1 that states "Can Drink NO Alcohol...Patient should be in an Alcohol Rehab Program". On 07/30/2024, R1, R1's Emergency Contact, ED, Health & Wellness Coordinator, and Resident Care Coordinator had a meeting to discuss the new order from R1's Doctor. R1 agreed to abide by the doctor’s order and was enrolled in an Alcohol Rehab Program.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Lourdes Montoya	TELEPHONE: (714) 748-2936
LICENSING EVALUATOR NAME: Lydia Martinez	TELEPHONE: (714) 705-6004
LICENSING EVALUATOR SIGNATURE:	DATE: 01/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2025

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-20250109160520

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: 01/15/2025

NARRATIVE

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On 01/09/2025, R1 presented a new doctor’s order stating R1 "May continue two mini-drinks at dinner" to the Health & Wellness Nurse. Interview with Dining Director, confirmed R1 received two glasses of wine during dinner on 01/09/2025. Facility was following doctor's orders to ensure R1’s health Is not endangered. Therefore, allegation that Facility failed to provide reasonable accommodation to a resident's needs & preferences is Unfounded meaning the allegation is false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted, and a copy of this report was sent to email on file.

SUPERVISOR'S NAME: Lourdes Montoya	TELEPHONE: (714) 748-2936
LICENSING EVALUATOR NAME: Lydia Martinez	TELEPHONE: (714) 705-6004
LICENSING EVALUATOR SIGNATURE:	DATE: 01/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2025

LIC9099 (FAS) - (06/04)

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