306000831-9-30-2025-22-AS-APAO-DM939M-20251007180318

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306000831
Report Date: 09/30/2025
Date Signed: 09/30/2025 02:57:49 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/24/2025 and conducted by Evaluator Sean Haddad

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20250924155802

FACILITY NAME:	BROOKDALE GARDEN GROVE		FACILITY NUMBER:	306000831
ADMINISTRATOR:	JERI MILES		FACILITY TYPE:	740
ADDRESS:	10200 CHAPMAN AVE		TELEPHONE:	(714) 636-6453
CITY:	GARDEN GROVE	STATE: CA	ZIP CODE:	92840
CAPACITY:	140	CENSUS: 124	DATE:	09/30/2025
		UNANNOUNCED	TIME BEGAN:	07:47 AM
MET WITH:	Brisseth Arrellano		TIME COMPLETED:	02:47 PM

ALLEGATION(S):

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Facility did not maintain a clean and sanitary environment

INVESTIGATION FINDINGS:

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This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of investigating the above-mentioned complaint allegation. LPA met with Administrator (AD) Brisseth Arrellano, discussed the purpose of the inspection, and explained the allegation.

The investigation into the allegation that facility did not maintain a clean and sanitary environment revealed the following: During the course of the investigation, LPA inspected the facility, conducted health and safety checks on residents, interviewed AD, residents, and staff, and obtained and reviewed copies of the resident roster, staff roster, and Resident #1’s (R1) Medical Records.

CONTINUED

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2025

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 22-AS-20250924155802

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: BROOKDALE GARDEN GROVE	FACILITY NUMBER: 306000831
	VISIT DATE: 09/30/2025

NARRATIVE

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It was alleged that R1 has gastrointestinal issues causing odor, staff open R1’s door to air out their room into the hallway, and the odor goes into other resident’s rooms causing illness. LPA inspected the entire facility, including the memory care and assisted living sections, common areas, hallways, and 16 resident rooms, including the room of R1 and their neighbors, and noted no bad odors. LPA interviewed four neighboring residents and did not obtain information corroborating any issues relating to smell in the area around R1’s room. LPA interviewed AD who stated that R1 receives incontinence care, does not have any gastrointestinal issues and has regular bowel movements, receives incontinence care with the hallway door closed and the patio door open, and requests that the hallway door be opened after incontinence care is completed and the facility does not deny R1 this personal right. Per AD, there is nothing out of the ordinary about R1 or their incontinence care, the same type of care is provided throughout the facility with no issue, R1 has been out of the facility for almost a month and no complaints were received from other residents about the incontinence care provided to R1 while it was taking place at the facility, and the facility takes general steps to address odors from incontinence care including opening the patio doors, using sprays and diffusers, and running the central air conditioning system. AD stated that the facility was unaware of the alleged odor issue while R1 was in the facility, but if R1 had been at the facility, AD would have inspected their room and asked neighboring residents to gauge the impact of the smell and would have taken appropriate measures to try to mitigate the impact. LPA interviewed one staff who denied the allegation, claiming they never observed any out of the ordinary smells with R1 and that R1 had no gastrointestinal issues. LPA reviewed R1’s Medical Records which indicate that as of September 3, 2025, R1 was not noted to have any gastrointestinal concerns or diagnoses by their doctor. The investigation did not reveal any information corroborating that other residents contracted any gastrointestinal issues from R1. No information was obtained corroborating that there were out of the ordinary smells coming from R1’s room, that any residents were bothered by smells coming from R1’s room, or that the facility did not properly address odors relating to incontinence care.

The Department has investigated the above allegation and found it to be Unfounded, meaning the allegation was false, could not have happened, or is without reasonable basis. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2025

LIC9099 (FAS) - (06/04)

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