306002962-4-16-2024-22-AS-AJLO-D4GMJW-20240419093948

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306002962
Report Date: 04/16/2024
Date Signed: 04/16/2024 04:13:33 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
04/11/2024 and conducted by Evaluator Ruth Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20240411162724

FACILITY NAME:	BROOKDALE BROOKHURST		FACILITY NUMBER:	306002962
ADMINISTRATOR:	JOHN GOODWIN		FACILITY TYPE:	740
ADDRESS:	15302 BROOKHURST ST		TELEPHONE:	(714) 775-6775
CITY:	WESTMINSTER	STATE: CA	ZIP CODE:	92683
CAPACITY:	164	CENSUS:	DATE:	04/16/2024
		UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	John Goodwin, Executive Director		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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A lack of care and supervision reulted in resident falling several times.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ruth Martinez made an unannounced visit to conduct the required 10-day visit to begin the investigation into the allegation listed above. LPA arrived at the facility was greeted by receptionist and granted entry. LPA met with John Goodwin, Executive Director and explained the nature of today’s visit.

Based on the information obtained during this investigation the Department as concluded the investigation into the above mentioned allegation. Findings are based upon this investigation which included interviews conducted, tour of the physical plant of the facility and copy of pertinent documents (face sheet, Services plan, physicians report dates 3/06/23 and 3/20/24, and admissions agreement). It is alleged that a lack of care and supervision resulted in resident falling several times. Record review revealed that resident

Continued on LIC9099

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (949) 430-1222
LICENSING EVALUATOR NAME: Ruth Martinez	TELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:	DATE: 04/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2024

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-20240411162724

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 BROOKHURST	FACILITY NUMBER: 306002962
	VISIT DATE: 04/16/2024

NARRATIVE

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(R1) was newly diagnosed with Parkinson disease on March 20, 2024. Personal service plan dated October 05, 2023, page 4 indicates R1 ambulates with a rolling walker independently throughout the community, although R1 prefers to stay in their room or in bed most of the time. R1 has episodes of dizziness and anxiety that causes R1 to have tremors and is prone to bedsides and bathroom falls. Staff to remind R1 to use call light pendent, request and wait for staff assistance when feeling anxious or dizzy. Staff to observe environment when assisting with meds, care and remove hazards. Remind R1 to wear non-skid sole slippers/shoes while ambulating. Communicate with primary care physician regarding falls and residents’ safety. Unusual incident/injury reports submitted to the Department reflect that facility has called 911 immediately upon R1 having falls. Report also indicate that R1 has had subsequent non-injury falls due to non-compliance with use of assistive device despite staff re-orientation and reminder to use walker. Reports indicate that on March 20, 2024 R1 was admitted to hospice care and service plan to be updated and reflect current needs. Tour of R1’s bedroom LPA observed a rollator walker with seat in the bathroom. Interviews with 4 of 4 staff indicate that the facility since resident had more fall implemented safety checks about two times every hour. Staff indicated that R1 does not like carrying pendent, forgets it or simply refuses to use it. Staff indicated that R1 must be reminded to use the walker even on short distance walks. Staff constantly remind R1 the importance of the pendent and to wear it as well as the importance of using the walker for ambulation assistance. R1 has always been very independent but facility has been proactive on implanting stand assist for R1 as needed and when requested. Staff indicated that they encourage proper use of assistive devices and additional personalization for falls management based on R1’s history and diagnosis while balancing independence, dignity, and choice.

Based on the information gathered during the investigation, the Department is unable to ascertain if the allegation 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, this allegation is deemed Unsubstantiated.

This report was reviewed with Executive Director and a copy was furnished to the facility.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (949) 430-1222
LICENSING EVALUATOR NAME: Ruth Martinez	TELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:	DATE: 04/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2024

LIC9099 (FAS) - (06/04)

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