374601952-8-20-2024-08-AS-JLOT-D8EVEX-20240823162301

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374601952
Report Date: 08/20/2024
Date Signed: 08/20/2024 09:55:22 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 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
01/25/2022 and conducted by Evaluator Rebecca A Ruiz

COMPLAINT CONTROL NUMBER: 08-AS-20220125151917

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: 90	DATE:	08/20/2024
		UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Business Office Manager Sam Elizondo		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Neglect to resident resulting in serious bodily injury

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced complaint visit to deliver findings regarding the above-mentioned allegation. LPA identified herself to, was greeted by, and explained the purpose of the visit to Business Office Manager Sam Elizondo.

The Department’s investigation consisted of interviews with residents, staff, and outside sources, records review, and a tour of the facility. It was alleged that neglect resulted in Resident 1 (R1) sustaining a fracture in January 2022. Review of R1’s physician’s reports dated November 2020 and August 2021 and R1’s needs and service plan dated February 2021 revealed that R1 did not have any memory impairment, was able to follow directions, was not confused or disoriented, and did not require assistance with transferring or ambulation. Additionally, R1 was receiving hospice services starting in August 2021 and R1 able to ambulate around the facility independently with the use of an electric wheelchair.

Continued on LIC9099-C page...

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Jennifer Lott	TELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Rebecca A Ruiz	TELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024

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-20220125151917

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: BROOKDALE OCEANSIDE	FACILITY NUMBER: 374601952
	VISIT DATE: 08/20/2024

NARRATIVE

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Interviews with staff, R1, and outside sources revealed that R1 had been complaining about shoulder pain starting approximately in December 2021 and was receiving pain medication on an as needed basis. Communication logs revealed that R1’s physician ordered an X-ray for R1’s arm in January 2022, which discovered a fracture on R1’s arm. R1 made statements during interviews that R1 believed that the fracture was due to a childhood injury that R1 further aggravated during R1’s career. R1 denied having fallen at the facility, being mistreated by staff, being dropped during a transfer, or experiencing any incidents that might have caused the fracture. R1 made statements during interviews that R1 would have voiced any concerns or complaints regarding the treatment R1 received from facility staff and that R1 did not have any complaints or concerns regarding the facility staff. Interviews with staff and outside sources corroborated R1’s statements and denied being made aware of any complaints R1 had made about care provided by facility staff.

Interviews with staff and outside sources revealed that R1 would transfer into a recliner by placing their arms behind their body and then dropping into the chair. R1’s physician and hospice staff stated that the way R1 transferred could have caused the fracture and that R1 had been cautioned against transferring in that manner. Additionally, staff and outside providers denied that R1 could have sustained the injury as the result of a fall due to R1’s inability to get up from the floor independently. Interviews with staff also revealed that prior to the discovery of R1’s fracture, R1 was independent of transferring needs but following the fracture, R1 required between two and three staff and the use of a gait belt to properly transfer.

The Department has investigated the above-mentioned allegation and based on interviews and records review, the preponderance of the evidence has not been met, therefore, this allegation is deemed unsubstantiated.

An exit interview was conducted with Business Office Manager Sam Elizondo, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).

SUPERVISOR'S NAME: Jennifer Lott	TELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Rebecca A Ruiz	TELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024

LIC9099 (FAS) - (06/04)

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