306002962-12-24-2024-22-AS-MTEA-DC9MXA-20241224085937

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306002962
Report Date: 12/24/2024
Date Signed: 12/24/2024 09:00:04 AM

Document Has Been Signed on 12/24/2024 09:00 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

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
ADMINISTRATOR/ DIRECTOR:	JOHN GOODWIN		FACILITY TYPE:	740
ADDRESS:	15302 BROOKHURST ST		TELEPHONE:	(714) 775-6775
CITY:	WESTMINSTER	STATE: CA	ZIP CODE:	92683
CAPACITY: 164	TOTAL ENROLLED CHILDREN: 0	CENSUS: 116	DATE:	12/24/2024
TYPE OF VISIT:	Case Management - Deficiencies	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:00 AM
MET WITH:	John Goodwin		TIME VISIT/ INSPECTION COMPLETED:	09:15 AM

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Licensing Program Analyst (LPA) Michael Tea made an unannounced visit on this day for the purposes of delivering findings into allegations of sexual abuse. On this day LPA was greeted and met with Business Office Manager (BOM) Danielle Chairez. Executive Director (ED) John Goodwin arrived shortly after.

On August 9, 2024, the Department received a self reported incident of suspected sexual abuse from the facility regarding Resident 1 (R1) and Staff 1 (S1). A health and safety visit was conducted by the Department on August 12, 2024, and an investigation initiated. The investigation determined as follows:

R1 moved into the facility on May 26, 2024. Per Physician Report dated May 10, 2024, R1 is able to self manage activities of daily living (ADLs) such as bathing, toileting, and dressing and is able to communicate their needs. R1’s personal service assessment dated May 06, 2024, also notates facility’s assessment that resident is independent in ADLs and has an intact cognitive response.

Per incident report received, R1 reported S1 engaged in sexually explicit conversations with them on multiple occasions over a period of approximately two months. In addition to engaging in sexually explicit conversations, R1 reported S1 showed them sexually explicit images on their personal phone including nude photographs of individuals they were dating and images of S1’s genitalia. Sometime in early August, R1 reported to a facility Med Tech (MT1) that S1 entered their room without knocking. R1 requested S1 not enter their room as they did not request any services and did not want assistance from S1. MT1 spoke with S1 and instructed them not to provide services to R1. The following day MT1 heard R1 yelling from their room at S1. S1 was observed leaving R1’s room.

Interviews with three of three residents confirmed R1 had disclosed to them inappropriate interactions between themselves and S1. Per interview with R1, S1 would often enter their room without knocking including when R1 was in the shower. R1 reported S1 would ask to help dress R1 despite R1 being assessed independent in that ADL. R1 further disclosed they had awoken once (date unknown) to S1 watching them sleep and informing them they had taken photos of R1 while they sleep because they look so pretty.

Case management report continued on LIC 809-C

Alisa Ortiz	TELEPHONE: (714) 287-4084
Michael Tea	TELEPHONE: 714-703-2840
	DATE: 12/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/24/2024

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

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 12/24/2024

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On August 1, 2024, Westminster Police Department conducted a visit to the facility to look into the allegations listed. Per review of records obtained, S1 when interviewed by police admitted making inappropriate comments and showing sexually explicit photographs to R1. S1 denied touching or attempting any sexual acts with R1. On August 07, 2024, the facility determined S1’s actions warranted termination for violation of facility harassment policies. The day of S1’s termination, S1 emailed ED Goodwin resigning from their position.

Based on interviews conducted and records reviewed, S1 engaged in behavior which violated R1’s personal rights. The following is being cited per California Code of Regulations, Title 22, Division 6.

An exit interview was conducted with Executive Director (ED) John Goodwin and a copy of this report, LIC809-D, appeal rights and confidential names list was provided to ED Goodwin.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 287-4084
LICENSING EVALUATOR NAME: Michael Tea	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 12/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/24/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 12/24/2024 09:00 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/24/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

87468.1(a)(1)- Personal Rights of Residents in all facilities. To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidence by:
	Deficient Practice Statement
1 2 3 4
	POC Due Date: 12/27/2024
	Plan of Correction
1 2 3 4	Management staff will provided written statement of understanding for regulation that was cited and emailed to LPA. And will conduct an inservice training on personal rights and provide proof to LPA by POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Alisa Ortiz	TELEPHONE: (714) 287-4084
Michael Tea	TELEPHONE: 714-703-2840
	DATE: 12/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/24/2024

LIC809 (FAS) - (06/04)

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