198204758-7-3-2025-11-AS-SCIS-DLFMFE-20250912093411

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198204758
Report Date: 07/03/2025
Date Signed: 07/03/2025 09:26:57 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/12/2025 and conducted by Evaluator Bernadette Allen

COMPLAINT CONTROL NUMBER: 11-AS-20250512120417

FACILITY NAME:	BROOKDALE OCEAN HOUSE		FACILITY NUMBER:	198204758
ADMINISTRATOR:	HELEN LEE		FACILITY TYPE:	740
ADDRESS:	2107 OCEAN AVE		TELEPHONE:	(310) 399-3227
CITY:	SANTA MONICA	STATE: CA	ZIP CODE:	90405
CAPACITY:	150	CENSUS: 109	DATE:	07/03/2025
		UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Helen Lee- Administrator		TIME COMPLETED:	09:35 AM

ALLEGATION(S):

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Licensee does not ensure enough staff to meet residents needs
Staff leave residents soiled for an extended period of time
Staff are not properly supervising residents who may be a fall risk
Staff are not answering call buttons in a timely manner

INVESTIGATION FINDINGS:

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***This report supersedes the original report delivered on 5/21/2025. On 7/3/2025 at 8:50AM, the LPA arrived at the facility to deliver the corrected 9099, providing clarification on the original report issued on 05/21/2025. ***

On 5/21/2025, at 9:19 AM Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to conduct and deliver findings for the alleged allegations. LPA identified herself and met Helen Lee-Administrator who was informed of the purpose of the visit.

The investigation consisted of the following:

On 5/21/2025 at 9:25 PM, LPA Allen requested and obtained the personnel and resident roster, unusual incident reports (UIRs), and observations of the internal incident log/notes. Additionally, LPA conducted interviews with twelve (12) residents and nine (9) staff members, as well as observations of residents and staff interactions during the visit.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2025

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 11-AS-20250512120417

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: BROOKDALE OCEAN HOUSE	FACILITY NUMBER: 198204758
	VISIT DATE: 07/03/2025

NARRATIVE

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Investigation revealed the following:

#1- Allegation: Licensee does not ensure enough staff to meet residents needs

LPA conducted interviews with twelve (12) residents (R1-R12), and 9 out of 12 residents stated the licensee ensures there is adequate staffing to meet their needs. LPA attempted to interview three (3) residents who chose not to participate in the process during the visit.

The interviews with nine (9) staff members (S1-S9), 9 staff members revealed that there is adequate staffing to meet the residents’ needs, although there may be instances where individuals call out. But alternate measures are taken to maintain adequate staffing daily by calling backup staff for coverage. LPA also observed the staff schedule for the month of May 2025 which appeared that there is sufficient staff to care for the needs of the residents.

#2- Allegation: Staff leave residents soiled for an extended period of time

LPA conducted interviews with twelve (12) residents (R1-R12), and 9 out of 12 residents reported that they are not left soiled for an extended periods, with staff checking on them every 2-3 hours or as needed. LPA attempted to interview three (3) residents who declined to participate in the interviewing process during the visit. Additionally, LPA observed staff performing routine checks and assisting residents who required care or support.

Interviews with nine (9) staff members (S1-S9) further indicated that they have not encountered any instances of a staff member or resident reporting that a resident was left soiled for an extended period. Staff stated residents are routinely checked on every 2-3 hours across all shifts to help the residents in care and or as needed.

#3- Allegation: Staff are not properly supervising residents who may be a fall risk

LPA conducted interviews with twelve (12) residents (R1-R12), and 9 out of 12 residents stated that they receive assistance with their needs, and the staff members are always encouraging them to use their ambulation devices to avoid falls. LPA attempted to interview three (3) residents who chose not to participate in the interview process during the visit. Additionally, LPA observed staff carrying out routine checks, encouraging residents to use their walkers, and assisting residents requiring care or support, contributing to fall prevention. LPA also noticed staff members assisting residents in the common area during the visit.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2025

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20250512120417

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: BROOKDALE OCEAN HOUSE	FACILITY NUMBER: 198204758
	VISIT DATE: 07/03/2025

NARRATIVE

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Interviews with nine (9) staff members (S1-S9) further stated staff members encourage and implement appropriate measures to ensure residents, including those at risk of falling, are properly supervised to prevent falls. Furthermore, staff stated residents are regularly checked on every 2-3 hours across all shifts to provide necessary care and support.

#4- Allegation: Staff are not answering call buttons in a timely manner

LPA conducted interviews with twelve (12) residents (R1-R12), and 9 out of 12 residents reported receiving assistance with their needs, with staff checking on them every 2-3 hours or as needed. Residents also stated when they use their call buttons, assistance is provided immediately. If staff members are occupied assisting others, alternate measures are taken by other staff to ensure residents receive timely support. LPA attempted to interview three (3) residents who declined to participate in the process during the visit. Additionally, LPA observed staff performing routine checks and assisting residents requiring care or support.

Interviews with nine (9) staff members (S1- S9) stated staff members implement appropriate measures to ensure residents receive timely assistance when using their call buttons, including those at risk of falling. Staff also stated that residents are routinely checked on every 2-3 hours across all shifts to provide necessary care and If staff members are occupied assisting others, alternate measures are taken by other staff to ensure residents receive timely support.

Based on observations, record reviews, and interviews with staff members and residents, the evidence gathered during the investigation indicates that the above allegation is unsubstantiated. This means that while the allegation may have occurred or holds validity, there is insufficient evidence to determine whether the alleged violations did or did not take place.

An exit interview was conducted where this report was discussed and provided to Helen Lee-Administrator at the conclusion of the visit.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2025

LIC9099 (FAS) - (06/04)

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