445294156-5-3-2023-26-AS-KHOS-CSQH9D-20230612055945

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 445294156
Report Date: 05/03/2023
Date Signed: 05/03/2023 05:59:50 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/21/2020 and conducted by Evaluator Ryker Heberle

COMPLAINT CONTROL NUMBER: 26-AS-20200921115629

FACILITY NAME:	BROOKDALE SCOTTS VALLEY		FACILITY NUMBER:	445294156
ADMINISTRATOR:	HARRISON, PAUL		FACILITY TYPE:	740
ADDRESS:	100 LOCKEWOOD LN		TELEPHONE:	(831) 438-7533
CITY:	SCOTTS VALLEY	STATE: CA	ZIP CODE:	95066
CAPACITY:	220	CENSUS: 118	DATE:	05/03/2023
		UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Jayden Bettencourt		TIME COMPLETED:	06:02 PM

ALLEGATION(S):

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Facility staff mismanage resident's medication.
Staff speak inappropriately to residents in care.
Staff do not ensure resident's toileting needs are being met.
Staff do not ensure that resident's showering needs are being met.

INVESTIGATION FINDINGS:

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Licensing Program Analyst Ryker Heberle (LPA) conducted an unannounced complaint investigation at the facility regarding the above allegations, LPA met with facility Assistant Executive Director Jayden Bettencourt (Admin).

During the course of the investigation, LPA toured the facility, interviewed 10 residents and 9 staff, and reviewed 6 resident records, and audited the facility medication room. During inspection of 6 resident medication records, all medication drawers were observed to be complete, and contain all prescribed medication. LPA did not observe any evidence of medication having been removed or tampered with in any capacity. During interviews with facility staff, 2 out of 9 staff interviewed stated that they were aware of suspicions of a particular staff member stealing resident medications 2-3 years ago. 7 out of 9 stated that they were not aware of any suspicious behavior or mismanagement of resident medication.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Ryker Heberle	TELEPHONE: 714-328-5152
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023

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 26-AS-20200921115629

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: BROOKDALE SCOTTS VALLEY	FACILITY NUMBER: 445294156
	VISIT DATE: 05/03/2023

NARRATIVE

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1 out of 9 staff members (S1) interviewed elaborated that suspicions of medication going missing during a particular staff member's shift, and reported their suspicions to management but never had their suspicions confirmed and was unsure of the results of internal facility investigations. Suspicious staff member identified by S1 stopped working at the facility an undetermined amount of months later, at which point medication stopped going missing.

During interviews with facility staff and residents, 10 out of 10 residents interviewed stated that they have never felt demeaned or spoken to in an inappropriate manner by staff. 10 out of 10 residents interviewed stated that facility staff was helpful and easy to work with. In interviews with facility staff, 9 out of 9 staff stated that they had never been made aware of or witnessed staff speaking to residents in an inappropriate manner. 5 out of 10 residents interviewed stated that they need assistance with daily living needs. 5 out of 5 residents that need assistance with ADLs stated that they receive assistance with showers once or twice a week. 5 out of 5 residents interviewed stated that they were satisfied with their shower service. 5 out of 5 residents interviewed stated that shower schedule remained consistent during lockdown periods.

1 out of 10 residents interviewed (R1) stated that while staff is normally helpful and prompt, there have been times when she is made to wait when she needs assistance. R1 stated that there was a instance where R1 needed help in the bathroom, pressed their pendant, and didn't receive assistance for an hour. R1 stated that the incident occurred a while ago, and was unable to provide a date. LPA was unable to verify incident in review of facility call logs.

This Department has investigated the above allegations. Based on observation, interviews and records review, the Department has determined that the allegations are UNSUBSTANTIATED, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

This report was reviewed with Assistant Executive Director Jayden Bettencourt and a signed copy of the report was provided.

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Ryker Heberle	TELEPHONE: 714-328-5152
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023

LIC9099 (FAS) - (06/04)

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