374601952-10-6-2023-08-AS-LTEZ-CWZTCQ-20231027143708

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374601952
Report Date: 10/06/2023
Date Signed: 10/06/2023 02:57:45 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, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/02/2023 and conducted by Evaluator Rebecca A Ruiz

COMPLAINT CONTROL NUMBER: 08-AS-20231002135512

FACILITY NAME:	BROOKDALE OCEANSIDE		FACILITY NUMBER:	374601952
ADMINISTRATOR:	CHRISTOPHER BURK		FACILITY TYPE:	740
ADDRESS:	3524 LAKE BLVD		TELEPHONE:	(760) 945-1811
CITY:	OCEANSIDE	STATE: CA	ZIP CODE:	92056
CAPACITY:	186	CENSUS: 88	DATE:	10/06/2023
		UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Business Office Manager Raquel Tarango		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Licensee did not take measures to keep the faciliity free from pests

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced complaint visit to open an investigation and deliver findings regarding the above mentioned allegation. LPA was greeted by, identified herself to, and explained the purpose of the visit and the basic elements of the complaint with Business Office Manager Raquel Tarango.

During today’s visit, LPA toured the facility, observed residents in care, reviewed and obtained copies of facility records, and interviewed residents and staff.

The Department's investigation consisted of interviews with residents and staff, records review, and a tour of the facility. It was alleged that the Licensee did not take measures to keep the facility free from pests. Interviews with staff revealed that the facility contracted with an outside company to conduct monthly pest control visits at the facility and facility staff were prohibited from using any chemicals or pesticides by the pest control company. Continued on LIC9099-C page...

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Rebecca A Ruiz	TELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2023

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 08-AS-20231002135512

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: BROOKDALE OCEANSIDE	FACILITY NUMBER: 374601952
	VISIT DATE: 10/06/2023

NARRATIVE

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Interviews with staff and residents revealed that some residents had complained about small flying insects in their rooms during their weekly housekeeping visits. Staff stated that they would report to the front desk or the maintenance director whenever a resident complained about insects or the staff observed insects. Interviews and records review revealed that the front desk staff were responsible for generating a work order and logging the issue in a binder at the front desk for the contracted pest control company to address during their monthly visit. Interviews revealed that the contracted pest control company would review the binder at the front desk and address each logged concern. Records review revealed that the pest control company was present at the facility once a month and left a receipt detailing the work conducted with the maintenance director. Interviews with staff revealed that staff would attempt to address any issues with insects during weekly housekeeping visits by using cleaning products in the areas where insects were observed. Interviews with staff revealed that insects were a concern around this time of year and denied any residents who had consistent issues with insects in their room.

Interviews with residents were inconsistent regarding the presence of insects in the facility and resident rooms. During the visit on 10/6/2023, LPA Ruiz observed multiple resident rooms, hallways, and common areas of the facility. LPA observed a few small flying insects in Resident 1’s (R1) room located around drink bottles and cups. Interviews with R1 revealed that the insects were attracted to open food containers and drinks which R1 admitted to leaving food containers out in the past. R1 stated that they did not wash drink cups or bottles with soap after they contained sugary drinks and only rinsed them out. R1 stated that they often ate meals in their room and returned any remaining food to the dining room after they completed their meal. R1 stated that the issue with insects had improved.

The Department has investigated the above-mentioned allegation and based on interviews and records review, the preponderance of the evidence has not been met, therefore, this allegation is deemed unsubstantiated.

An exit interview was conducted with Business Office Manager Raquel Tarango, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 01/16).

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Rebecca A Ruiz	TELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2023

LIC9099 (FAS) - (06/04)

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