374601952-8-30-2022-08-AS-SJAB-CHU2FJ-20220831172138

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374601952
Report Date: 08/30/2022
Date Signed: 08/30/2022 09:40:02 AM

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
01/20/2022 and conducted by Evaluator Sabel Martinez

COMPLAINT CONTROL NUMBER: 08-AS-20220120104809

FACILITY NAME:	BROOKDALE OCEANSIDE		FACILITY NUMBER:	374601952
ADMINISTRATOR:	DANIELLE HAUSEMAN		FACILITY TYPE:	740
ADDRESS:	3524 LAKE BLVD		TELEPHONE:	(760) 945-1811
CITY:	OCEANSIDE	STATE: CA	ZIP CODE:	92056
CAPACITY:	186	CENSUS: 100	DATE:	08/30/2022
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Executive Director, Foudhil Manadi		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Neglect/Lack of Supervision to resident resulting in fall and injury

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Sabel Martinez, conducted an unannounced complaint visit to deliver findings regarding the above-mentioned allegation. The LPA was greeted by Executive Director, Foudhil Mnadi, identified himself, and disclosed the purpose of the visit.

The Department’s investigation consisted of review of records, and interviews with internal and external sources.

It was alleged neglect, Lack of Supervision to a resident resulted in fall and injury.Resident #1 (R1) moved into the facility on 12/3/21, and was at the facility from approximately 12pm to 8pm. R1 sustained two falls within this timeframe. The second fall resulted in a laceration to the eyebrow, and R1 was transported to the hospital. An interview with an outside source corroborated this information to be true. Obtained records revealed R1 was a fall risk, used mobility aids, often attempted to walk and transfer without assistance, and had a history of recent falls.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (610) 767-2317
LICENSING EVALUATOR NAME: Sabel Martinez	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2022

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-20220120104809

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: 08/30/2022

NARRATIVE

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Interviews with internal sources revealed residents in the memory care unit were frequently observed and encouraged to participate in community activities. If a resident decided to spend time in the resident’s room, staff would conduct hourly to half hour checks. The time frame of the checks was dependent on the resident’s needs at that specific time. On 12/3/21, R1 was assisted to the dining room for dinner and assisted back to R1’s room after. A few minutes later, R1 was found on the ground with a laceration to the eyebrow and was transported to the hospital. Documents obtained at the facility revealed the facility does not provide one to one care and supervision, and residents were able to hire a third party to provided additional services, including assistance and companionship. An interview with an outside source who conducted regular visits to the facility did not disclose any concerns regarding neglect, nor lack of supervision at the facility.

Based on the evidence gathered throughout the investigation, there is not a preponderance of evidence to prove the alleged violation occurred, therefore, the allegation is unsubstantiated.

An exit interview was conducted with Executive Director, Foudhil Manadi, to whom a copy of this report, and Licensee's Rights (LIC 9058 01/16) were provided to

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (610) 767-2317
LICENSING EVALUATOR NAME: Sabel Martinez	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2022

LIC9099 (FAS) - (06/04)

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