374601952-12-6-2022-08-AS-LTEZ-CM2VTF-20221212154300

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374601952
Report Date: 12/06/2022
Date Signed: 12/06/2022 10:11:45 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
09/06/2022 and conducted by Evaluator Rebecca A Ruiz

COMPLAINT CONTROL NUMBER: 08-AS-20220906173219

FACILITY NAME:	BROOKDALE OCEANSIDE		FACILITY NUMBER:	374601952
ADMINISTRATOR:	MANADI, FOUDHIL		FACILITY TYPE:	740
ADDRESS:	3524 LAKE BLVD		TELEPHONE:	(760) 945-1811
CITY:	OCEANSIDE	STATE: CA	ZIP CODE:	92056
CAPACITY:	186	CENSUS: 91	DATE:	12/06/2022
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Mario Preston & Chris Burk		TIME COMPLETED:	10:15 AM

ALLEGATION(S):

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Licensee did not observe resident's change in condition
Staff served expired food to residents
Staff did not follow food sanitation practices

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced complaint investigation visit to deliver findings regarding the above-mentioned allegations. LPA identified herself to, was greeted by, and explained the purpose of the visit to Executive Directors Mario Preston and Chris Burk.

The Department’s investigation consisted of observations, interviews with staff, residents, and outside sources, review of records, and a tour of the facility. It was alleged that the Licensee did not observe resident’s change in condition specific to wound care. Interviews with facility staff revealed that there were three residents at the facility that received wound care from outside agencies. Interviews with the Health and Wellness Director (HWD) revealed that the residents received wound care one to three times a week and the care provided by those outside agencies included wound treatment and applying bandages to the wound.

Continued on LIC9099-C page

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Rebecca A Ruiz	TELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2022

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-20220906173219

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: 12/06/2022

NARRATIVE

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Facility staff were trained to call the outside agency if the wound smelled, looked infected, had any changes, or if the bandage slipped or fell off. Facility medication technicians and nurses had received training to replace the bandage on the wound if needed, but were still instructed to call the outside agency to notify them of the changes. Interviews with the outside agencies revealed that there are no concerns about facility staff reaching out to them regarding residents’ wound care. Interviews with Resident 1’s (R1) home health nurse stated that R1 was non-compliant with wound care and would not allow staff or outside agency staff to observe or care for the wound. R1’s nurse arranged a care conference with the facility’s HWD to discuss R1’s wound. Interviews with HWD stated that R1 would be non-compliant with home health nurses depending on how they approached R1 and would agree to care from some nurses and deny care from others. Review of home health care documents revealed that R1 occasionally denied services but was able to receive wound care services. HWD stated that R1’s wound had healed as of October 21, 2022 and R1 is no longer receiving wound care services.

It was alleged that staff served expired food to residents and did not follow food sanitation practices. Interviews with the staff revealed that staff conduct inventory on the facility’s food supply and order food supplies once a week. Staff are directed to fill out a food label when preparing food which includes the name of the food, the date prepared, the expiration date of the food, the food’s shelf-life time period, the preparer’s initials, and the manager’s initials. During the initial visit on August 15, 2022, LPA Ruiz observed food in the facility’s walk-in refrigerator and freezer that had the date prepared but did not have the expiration date or a shelf-life time period. LPA Ruiz did not observe any food that was spoiled or rotten during the initial visit. Interviews with the Dining Services Director (DSD) revealed that there is a specific staff member that is having an ongoing problem with not putting the expiration date on food. Interviews with dining staff revealed that any food that is identified as spoiled or expired is thrown out. Interviews with residents revealed that residents like the food served at the facility and have not observed any spoiled or expired meals. Interviews with staff revealed that dining staff are responsible for cooking and preparing meals in the facility kitchen, placing the food into warming boxes that are used to transport food to the facility’s two dining rooms for assisted living and the two memory care areas.

Continued on LIC9099-C page.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Rebecca A Ruiz	TELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2022

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20220906173219

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: 12/06/2022

NARRATIVE

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Dining staff transfer the food into steam trays in kitchenettes located in each dining room and plate and serve food to residents. In memory care, dining staff transport the warming boxes to the memory care kitchenettes where memory care staff place the food into steam trays and plate and serve residents. Interviews with the DSD revealed that dining staff use gloves when preparing food.

The Department has investigated the above-mentioned allegations and based on interviews, observations, and review of records, the preponderance of the evidence has not been met, therefore, these allegations are deemed unsubstantiated.

An exit interview was conducted with Executive Directors Mario Preston and Chris Burk, to whom a copy of this report and the Licensee Appeal Rights (LIC9058 01/16) were provided via hard copy.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Rebecca A Ruiz	TELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2022

LIC9099 (FAS) - (06/04)

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