306002962-10-29-2020-22-AS-SSAS-BV7NGP-20201109092728

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306002962
Report Date: 10/29/2020
Date Signed: 10/29/2020 03:27:43 PM

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
07/31/2020 and conducted by Evaluator James August

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200731092435

FACILITY NAME:	BROOKDALE BROOKHURST		FACILITY NUMBER:	306002962
ADMINISTRATOR:	KIMIA ATAEIAN		FACILITY TYPE:	740
ADDRESS:	15302 BROOKHURST ST		TELEPHONE:	(714) 775-6775
CITY:	WESTMINSTER	STATE: CA	ZIP CODE:	92683
CAPACITY:	164	CENSUS: 92	DATE:	10/29/2020
		UNANNOUNCED	TIME BEGAN:	03:07 PM
MET WITH:	Kimia Ataeian, Executive Director		TIME COMPLETED:	03:08 PM

ALLEGATION(S):

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Staff is not providing adequate care to residents
Staff member yells at the residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jim August contacted the facility via video telephone to conclude a complaint investigation via telephone due to COVID-19 and precautionary measures. LPA identified himself and discussed the purpose of the call. The initial 10-day visit was completed on August 5, 2020.
The investigation into the allegations that facility staff are not providing adequate care to residents and staff yell at residents revealed the following:

On August 5, 2020 LPA August interviewed Executive Director Kimia Ataeian. Ataeian stated that she had no knowledge of any staff members yelling at residents or failing to provide care and services for residents. It was alleged that a staff member, staff 1 (S1) was yelling at residents and neglecting to provide food, changing them or provide care and services to the residents. Ataeian stated that no residents or other staff members ever reported any of the above allegations against S1 or any other staff.
CONTINUED ON LIC9099C DATED OCTOBER 29, 2020....

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: James August	TELEPHONE: 714-703-2853
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2020

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-20200731092435

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 BROOKHURST	FACILITY NUMBER: 306002962
	VISIT DATE: 10/29/2020

NARRATIVE

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On October 15, 2020 LPA interviewed four (4) residents in the memory care unit. None of the residents corroborated that any staff members yelled at residents, neglected them or failed to provide them with their needs and services.

On October 29, 2020 LPA interviewed staff 2 (S2) and staff 3 (S3). Both S2 and S3 worked in the memory care unit with S1. S2 and S3 stated that they never saw S1 yell at residents, fail to respond to calls, or fail to provide the residents with their daily needs. S2 and S3 stated that S1 was hard working and cared for the residents.

LPA reviewed and obtained S1’s staff file and found no records of S1 failing to complete job duties or yelling at residents.

As such, there is insufficient evidence to corroborate whether the above allegations have occurred. With the information obtained through the means described above, we have found the above allegations unsubstantiated. Although the allegations may have happened or may be valid; there is not a preponderance of evidence to prove that the alleged violations occurred.

An exit interview was conducted with Executive Director Kimia Ataeian via video-telephone and a copy of this report was provided to Ataeian via email. Ataeian to sign all pages of the report and return the signed copy to LPA August within 24 hours.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: James August	TELEPHONE: 714-703-2853
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2020

LIC9099 (FAS) - (06/04)

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