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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306002955
Report Date: 04/12/2022
Date Signed: 04/12/2022 11:37:55 AM

Substantiated


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
04/08/2022 and conducted by Evaluator Michelle Reed
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20220408114452
FACILITY NAME:BROOKDALE NOHL RANCHFACILITY NUMBER:
306002955
ADMINISTRATOR:HAMMERS, LANAFACILITY TYPE:
740
ADDRESS:380 S ANAHEIM HILLS RDTELEPHONE:
(714) 974-1616
CITY:ANAHEIM HILLSSTATE: CAZIP CODE:
92807
CAPACITY:266CENSUS: 69DATE:
04/12/2022
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Lana HammersTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Licensee is not providing housekeeping due to lack of staffing
INVESTIGATION FINDINGS:
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Licensing Program Analyst Michelle Reed arrived at the facility to discuss the complaint allegation. Upon arrival, LPA met with Administrator Lana Hammers. According to Ms. Hammers, the facility lost both of their housekeepers in December 2021. Staff, including the Maintenance Director, Administrator and Driver have been assisting wherever they can. Housekeeping is being conducted just not as it was before the loss of staffing. It has been very challenging to find staff and Brookdale is currently using a staffing agency for care staff. The care staff pick up the trash in the evening and some do personal laundry. They do not clean apartments or change bedding, unless providing care to a resident. A new housekeeper was hired on 4/5/22 and Brookdale is also looking into a staffing agency for housekeeping.

Based upon interviews and documentation the preponderence of evidence has been met and the allegation is substantiated. See LIC9099D for cited deficiency.

An exit interview was conducted and a copy of this report and appeal rights were provided to Lana Hammers.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: Michelle ReedTELEPHONE: (714) 743-4958
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2022
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-20220408114452
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 NOHL RANCH
FACILITY NUMBER: 306002955
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/12/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/15/2022
Section Cited
CCR
87411(a)
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Personnel Requirements General -Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, additional staff shall be employed to perform house cleaning, laundering, and maintenance of buildings.
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Administrator agrees to continue looking for new staff. Brookdale is also looking to use a staffing agency for housekeeping. A plan will be set in place by Friday 4/15, if not sooner.

The plan will be sent to Licensing by 4/15/22..
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This requirement was not met as evidenced by:

Facility does not have enough housekeeping staff to meet the needs of residents. This poses a potential health and safety/personal rights risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: Michelle ReedTELEPHONE: (714) 743-4958
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2