306002962-5-25-2023-22-AS-MSTC-CUA6WB-20230731211004

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306002962
Report Date: 05/25/2023
Date Signed: 05/25/2023 01:07:01 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
04/21/2023 and conducted by Evaluator Celine DePerio

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230421164451

FACILITY NAME:	BROOKDALE BROOKHURST		FACILITY NUMBER:	306002962
ADMINISTRATOR:	LUIS B RODRIGUEZ		FACILITY TYPE:	740
ADDRESS:	15302 BROOKHURST ST		TELEPHONE:	(714) 775-6775
CITY:	WESTMINSTER	STATE: CA	ZIP CODE:	92683
CAPACITY:	164	CENSUS: 69	DATE:	05/25/2023
		UNANNOUNCED	TIME BEGAN:	09:42 AM
MET WITH:	Facility Administrator - John Goodwin		TIME COMPLETED:	01:25 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are not responding to residents pendent timely
Facility has insects
Facility does not have toiletries for public bathrooms

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Celine De Perio conducted an unannounced visit at the facility to deliver the findings for the complaint received on 4/21/23. LPA De Perio explained reason for visit, was greeted by front desk staff, and met with Executive Director (ED) John Goodwin.

During the investigation, LPA De Perio toured the physical plant of the facility, conducted interviews and requested copies of pertinent records reviewed.

It was alleged that staff are not responding to residents pendent timely. LPA De Perio conducted a tour of resident rooms and tested random pendants, of which staff responded within 10-14 minutes. LPA De Perio conducted a total of 11 interviews that consisted of staff and residents. 6 out of the 11 interviews conducted stated that it takes "around 15 to 30 minutes" for staff to respond.

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: 05/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023

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 5

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
04/21/2023 and conducted by Evaluator Celine DePerio

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230421164451

FACILITY NAME:	BROOKDALE BROOKHURST		FACILITY NUMBER:	306002962
ADMINISTRATOR:	LUIS B RODRIGUEZ		FACILITY TYPE:	740
ADDRESS:	15302 BROOKHURST ST		TELEPHONE:	(714) 775-6775
CITY:	WESTMINSTER	STATE: CA	ZIP CODE:	92683
CAPACITY:	164	CENSUS: 69	DATE:	05/25/2023
		UNANNOUNCED	TIME BEGAN:	09:42 AM
MET WITH:	Facility Administrator - John Goodwin		TIME COMPLETED:	01:25 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff serve contaminated water to resident
Facility is malodorous

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Celine De Perio conducted an unannounced visit at the facility to deliver the findings for the complaint received on 4/21/23. LPA De Perio explained reason for visit, was greeted by front desk staff, and met with Executive Director (ED) John Goodwin.

During the investigation, LPA De Perio toured the physical plant of the facility, conducted interviews and requested copies of pertinent records reviewed.

It was alleged that staff serve contaminated water to resident. LPA De Perio conducted a tour of the physical plant of the facility, record reviews and interviews. During the tour of the facility kitchen, bathroom and resident rooms, LPA De Perio did not observe any indicatation of water contamination. LPA De Perio reviewed facility maintenance records specifically regarding the water/plumbing system, and it was observed that there are no records that indicated any forms of water contamination due to no concerns regarding this manner.

Unfounded

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: 05/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023

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

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 22-AS-20230421164451

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 BROOKHURST	FACILITY NUMBER: 306002962
	VISIT DATE: 05/25/2023

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

LPA De Perio conducted a total of 11 interviews which consisted of staff and residents. 11 out of the 11 interviews did not corroborate with the allegation by all denying the allegation.

It was alleged that facility is malodorous. LPA De Perio conducted a tour of the physical plant of the facility, reviewed records and conducted interviews. LPA De Perio toured resident rooms, and facility rooms (such as the activity room, dining room, public restrooms and kitchen). LPA De Perio did not observe any odor, and observed facility staff regularly cleaning resident rooms. LPA De Perio conducted a total of 11 interviews, of which 11 out of the interviews did not corroborate with the allegation by denying the allegation.

Based on observations and review of documents obtained, we have found that the allegations indicted were UNFOUNDED, meaning that the allegations were false, could not have happened and/or is without a reasonable basis.

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

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerio	TELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 22-AS-20230421164451

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 BROOKHURST	FACILITY NUMBER: 306002962
	VISIT DATE: 05/25/2023

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

2 out of the 11 interviews conducted stated "the goal is no more than 20 minutes". LPA De Perio reviewed pendant reports and observed that the staff response time varied from 15-45 minutes, however 2 interviews reported that "sometimes they forget to reset it".

It was alleged that facility has insects. During the tour, LPA De Perio toured resident rooms and facility rooms and did not observe any insects. 11 interviews were conducted with staff and residents and 7 interviews did not corroborate with the allegation. 4 out of the 11 interviews conducted reported of observing insects, of which 1 interview stated, "there is an occasional bug here and there but it's just like one. Not a lot". LPA De Perio reviewed documents regarding pest control, and observed that although the facility is partnered with a pest company, within the past months, there have been no instances or issues regarding insects.

It was alleged that facility does not have toiletries for public bathrooms. LPA De Perio toured each public restroom and observed that each bathroom had toiletries such as toilet paper, paper towels, and hand soap. LPA De Perio conducted a total of 11 interviews of which 7 did not corroborate with the allegation, and 4 stated that "sometimes" there is a shortage of supplies.

Based on the information gathered during the investigation and review of documents obtained, 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 the evidence to prove or refute the alleged violations occurred; therefore, the allegations are deemed UNSUBSTANTIATED.

For this visit, no citations were issued.

An exit interview was conducted with ED Goodwin. A copy of this reported was provided and explained.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerio	TELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023

LIC9099 (FAS) - (06/04)

Page: 5 of 5