306002962-10-4-2023-22-AS-AORZ-CWKM2P-20231013091353

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306002962
Report Date: 10/04/2023
Date Signed: 10/04/2023 12:45:09 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
09/27/2023 and conducted by Evaluator Alvaro Ramirez Jr.

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230927104948

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: 97	DATE:	10/04/2023
		UNANNOUNCED	TIME BEGAN:	09:09 AM
MET WITH:	John Goodwin-Executive Director		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff do not respond to resident calls on the signal system.
Facility’s signal system is not functioning properly.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced initial 10-Day complaint visit to initiate the investigation into the above allegations and to deliver the findings of the investigation. LPA was greeted and granted entry into the facility and met with Executive Director (ED) John Goodwin. LPA explained the reason for the visit.

On today’s visit LPA Ramirez conducted file reviews and interviews and obtained copies of pertinent documents. Regarding the allegation that facility staff do not respond to resident calls on the signal system, the following was revealed: Three of four residents interviewed denied the allegation. At 9:35 AM LPA tour the facility and tested four pendants in four resident bedrooms. The average staff respond time range from 40 seconds to 13 minutes and 10 seconds. During the interviews with residents it was reported that staff do not respond fast and/or that staff respond within 15-30 minutes. During the course of the interviews ED stated that the average respond time is within 20 minutes and/or that staff respond timely.
Continued on LIC9099-C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2023

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-20230927104948

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: 10/04/2023

NARRATIVE

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During the course of the investigation LPA reviewed documents including the Smartcare pendant call log dated 09/25/23 and 09/26/23. Per Smartcare pendant call log the average staff respond time ranges from one minute to 59 minutes.

Regarding the allegation that facility’s signal system is not functioning properly, the investigation revealed the following: Three of four residents interviewed denied the allegation. Per interviews conducted with residents it was reported that the signal system does not always work but that if the pendant is not working properly that staff will replace it within 15 minutes. It was reported via interviews by Staff 1 (S1) that sometimes the pendants do not work properly but that it will get replaced right away. Per S1 the signal system has been working properly.

Based on LPA's observation and information gathered during the investigation, LPA is unable to ascertain if the allegations occurred as reported due to conflicting information. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove or refute the alleged violations occurred; therefore, the allegations are deemed UNSUBSTANTIATED.

LPA Ramirez conducted an exit interview with ED Goodwin, and a copy of this report was provided to the facility.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2023

LIC9099 (FAS) - (06/04)

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