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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336426239
Report Date: 12/28/2021
Date Signed: 12/28/2021 03:30:39 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/09/2021 and conducted by Evaluator David Cuevas
COMPLAINT CONTROL NUMBER: 18-AS-20211209160912
FACILITY NAME:BROOKDALE SUNWESTFACILITY NUMBER:
336426239
ADMINISTRATOR:SORIANO, MARIAN MFACILITY TYPE:
740
ADDRESS:1085 SUNWEST DRTELEPHONE:
(951) 925-0822
CITY:HEMETSTATE: CAZIP CODE:
92545
CAPACITY:60CENSUS: 33DATE:
12/28/2021
UNANNOUNCEDTIME BEGAN:
11:12 AM
MET WITH:Associate Executive Director, Eloiza CastellanosTIME COMPLETED:
03:20 PM
ALLEGATION(S):
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Facility lacks sufficient staff to meet the needs of the residents in care.
INVESTIGATION FINDINGS:
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On 12/28/21 Licensing Program Analyst (LPA) David Cuevas conducted an unannounced visit for the purpose of following up with investigating the allegations above. LPA identified self and was granted entree. LPA met with Associate Executive Director, Eloiza Castellanos who was informed of the purpose of visit.

During this investigation LPA conducted the following: Staff and resident interviews, walkthrough of facility, resident record review, facility file review, and made observations.

Regarding Allegation: Facility lacks sufficient staff to meet the needs of the residents in care.

The department initiated an investigation due to reports that facility lacks sufficient staff to meet the needs of residents in care.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: David Cuevas
LICENSING EVALUATOR SIGNATURE:

DATE: 12/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2021
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
Control Number 18-AS-20211209160912
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: BROOKDALE SUNWEST
FACILITY NUMBER: 336426239
VISIT DATE: 12/28/2021
NARRATIVE
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An initial visit was done to facility on 12/15/21 to initiate investigation, during that visit at approximately 11:30 AM, LPA toured the facility along with Staff# (S1) and observed a total of 1 caregiver in memory unit for 12 residents and 1 caregiver in assisted living for a total of 21 residents, with 1 medical technician to share for both memory and assisted living units.

Through interviews with staff it was communicated to LPA that normally caregiver coverage for each unit should reflect, 2 caregivers in each unit and 1 one medical technician to be shared by both units for support during the day hours, and during the overnight hours 1 caregiver in each unit and 1 shared medical technician both units. Although LPA was informed that when staff shortages and gaps occur administrative staff provide support and coverage, per staff and residents interviews this adjustment in not enough to meet the needs of residents.

Furthermore, a second follow up visit was conducted on 12/28/21 in which LPA toured the facility grounds approximately 12:30 PM along with S1, and identify facility to yet again have only 1 caregiver in memory unit for 12 residents and 1 caregiver in assisted living for a total of 22 residents, with 1 medical technician to be share for both memory and assisted living units. Furthermore, review of resident records and LPA’s observations identify resident #1(R1) in room # 101, to need a Hoyer lift to help with incontinence care, bathing, and getting out a bed, a task that requires at least 2 caregivers, per staff interviews. Based on the review of staff schedules, interviews, and the needs of R1, facility lacks sufficient staff to meet the needs of residents in care, as such allegation of Facility lacks sufficient staff to meet the needs of the residents in care is being SUBSTANTIATED.

A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met.

An exit interview was conducted where this report, LIC 9099 D, and appeal rights were discussed with and provided to Associate Executive Director, Eloiza Castellanos
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: David Cuevas
LICENSING EVALUATOR SIGNATURE:

DATE: 12/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2021
LIC9099 (FAS) - (06/04)
Page: 5 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/09/2021 and conducted by Evaluator David Cuevas
COMPLAINT CONTROL NUMBER: 18-AS-20211209160912

FACILITY NAME:BROOKDALE SUNWESTFACILITY NUMBER:
336426239
ADMINISTRATOR:SORIANO, MARIAN MFACILITY TYPE:
740
ADDRESS:1085 SUNWEST DRTELEPHONE:
(951) 925-0822
CITY:HEMETSTATE: CAZIP CODE:
92545
CAPACITY:60CENSUS: 33DATE:
12/28/2021
UNANNOUNCEDTIME BEGAN:
11:12 AM
MET WITH:Associate Executive Director, Eloiza Castellanos TIME COMPLETED:
03:20 PM
ALLEGATION(S):
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9
Residents are made to wait an excessive amount of time to receive assistance from staff.
INVESTIGATION FINDINGS:
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On 12/28/21 Licensing Program Analyst (LPA) David Cuevas conducted an unannounced visit for the purpose of following up with investigating the allegations above. LPA identified self and was granted entree. LPA met with Associate Executive Director, Eloiza Castellanos who was informed of the purpose of visit.

During this investigation LPA conducted the following: Staff and resident interviews, walkthrough of facility, resident record review, facility file review, and made observations.

Regarding Allegation: Residents are made to wait an excessive amount of time to receive assistance from staff.


Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: David Cuevas
LICENSING EVALUATOR SIGNATURE:

DATE: 12/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2021
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 18-AS-20211209160912
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: BROOKDALE SUNWEST
FACILITY NUMBER: 336426239
VISIT DATE: 12/28/2021
NARRATIVE
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During a visit conducted on 12/28/21 LPA toured the facility grounds approximately 12:30 PM along with S1, and conducted random interviews in rooms # 117, # 100, # 113,# 205, and room # 202, interviewing residents. Based on collected interviews, 5 out of 5 residents reported to be content with wait time, when receiving assistance from staff. Additionally, review of call light and pendant records shows a pattern of appropriate response to resident’s call. As such the allegation of, Residents are made to wait an excessive amount of time to receive assistance from staff, is being UNSUBSTANTIATED at this time, meaning that although the allegation may have happened or is valid, there is not enough preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

An exit interview was done with Associate Executive Director, Eloiza Castellanos were a copy of this report was reviewed and provided.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: David Cuevas
LICENSING EVALUATOR SIGNATURE:

DATE: 12/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 18-AS-20211209160912
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: BROOKDALE SUNWEST
FACILITY NUMBER: 336426239
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/28/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/11/2022
Section Cited
CCR
87411(a)
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Personnel Requirements (a): (a) 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, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services.This requirement was not met evidence by:
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Facility will evaluate the needs of all residents in care and adjust staffing to ensure residents needs are met. New staffing shedule will be provided to LPA by 01/11/22 for review before difienciency can be cleared.
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During visits to facility both assisted living and memory units had a total of 1 caregiver and 1 shared medical technician to provide care and supervision for residents in care; however, R1 in assisted living required a hoyer lift that would require the need for at least 2 caregiver to operate, This posed a potential risk to the health, safety, and personal rights of 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.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: David Cuevas
LICENSING EVALUATOR SIGNATURE:

DATE: 12/28/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 5