306002954-8-26-2022-22-AS-MSTC-CJ55TN-20220909201437

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306002954
Report Date: 08/26/2022
Date Signed: 08/26/2022 11:58:05 AM

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
08/23/2021 and conducted by Evaluator Sean Haddad

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20210823161046

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: 101	DATE:	08/26/2022
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Becky Kruse		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff not properly trained on emergency procedures
Not enough staff to ensure the safety of residents

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of delivering findings for the investigation into the above identified complaint allegations. LPA met with Wellness Director (WD) Becky Kruse and explained the reason for today’s inspection.

The investigation into the allegations that staff are not properly trained on emergency procedures and there are not enough staff to ensure the safety of residents revealed the following: During the course of the investigation, LPA conducted on-site inspections on 08/27/21 and 10/19/21, inspected the facility, interviewed Administrator (AD) Carrie Galloway and residents, and obtained and reviewed copies of facility records.

It was reported that, when the fire alarm went off on 08/21/21, there were not enough staff to direct residents and that the staff present were not properly trained on emergency procedures, which resulted in confusion during the alarm. AD stated that the fire alarm on 08/21/21 was a false alarm, the facility quickly determined it to be a false alarm, and so shortly after the alarm rang residents and staff were free to use the elevators.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 2

Control Number 22-AS-20210823161046

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: 08/26/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

AD stated that, per the facility’s emergency procedures, when the fire alarm goes off, the fire doors close (but do not lock), residents are supposed to stay in in their rooms, and staff go section to section (going through the fire doors) checking on the residents or evacuating residents if necessary. Per AD, facility staff responded on 08/21/21 exactly how they were trained to respond. In terms of training, AD stated that residents are offered monthly training on fire safety, there is an annual evacuation drill, and staff are trained on fire precautions upon hire and yearly thereafter. LPA reviewed and confirmed the facility’s Fire and Emergency Evacuation Plan, Evacuation Plan, Facility Protocol for Evacuation, and Resident Emergency Guide which corroborate AD’s description of the fire protocols and document the fire protocols for staff and residents. LPA reviewed Direct Supply Tels Logbook Documentation showing that the facility regularly conducts fire drills. LPA reviewed facility training records which show all staff completed at least 2 fire training sessions in 2021. During LPA’s inspection on 08/27/21, LPA observed a spontaneous false fire alarm at the facility. During the alarm, LPA observed staff come to the front to receive instructions, the facility’s determination that the alarm was a false alarm, and staff proceeding to check on residents in an orderly manner. LPA interviewed 5 residents, 4 of whom corroborated AD’s statement that the facility’s fire protocol was properly followed on 08/21/21. LPA’s interview with AD and review of documents revealed that on 08/21/21, the facility had approximately 118 residents and had 5 caregivers, 1 office staff, 1 receptionist, and 6 kitchen staff, all of whom are trained on emergency procedures. During LPA’s inspections on 08/27/21 and 10/19/21, LPA did not observe a shortage of staff, and during the 08/27/21 inspection LPA observed staff checking on residents in an orderly manner. LPA interviewed 5 residents, none of whom stated the facility did not have enough staff to check on and direct residents during the 08/21/21 false alarm.

Based on the information gathered during the investigation and review of all documents obtained, the Department is unable to ascertain if the allegations occurred as reported. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, these allegations are deemed Unsubstantiated. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 2