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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306002954
Report Date: 06/11/2025
Date Signed: 06/11/2025 03:55:11 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
05/03/2024 and conducted by Evaluator Celine Rodriguez
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20240503163000
FACILITY NAME:BROOKDALE IRVINEFACILITY NUMBER:
306002954
ADMINISTRATOR:CARRIE GALLOWAYFACILITY TYPE:
740
ADDRESS:10 MARQUETTETELEPHONE:
(949) 854-3766
CITY:IRVINESTATE: CAZIP CODE:
92612
CAPACITY:155CENSUS: 146DATE:
06/11/2025
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Sharin Belanger - Business Office ManagerTIME COMPLETED:
04:20 PM
ALLEGATION(S):
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Staff did not respond to resident's call button in a timely manner
Staff spoke inappropriately towards resident
Staff are not providing adequate food service to resident
Staff did not meet resident's hygiene needs
Staff are not meeting resident's needs
Staff did not safeguard resident's personal belongings
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Celine Rodriguez conducted an unannounced visit to the facility to continue the investigation and to deliver the findings. LPA Rodriguez explained the purpose of today's visit and was greeted by business office manager (BOM) Sharin Belanger.

It was alleged that staff did not respond to resident's call button in a timely manner. LPA Rodriguez conducted a total of 10 resident interviews of which all 10 resident interviews did not corroborate with the allegation. It was verified by residents that staff do respond to a resident's call button. 1 out of 1 staff interview did not corroborate with the allegation by stating that the target response time when a call button is pressed, is to be no longer than 30 minutes. Per record review of the pendant report, in the month of April and May, staff responded to a resident's call button between 7 to 24 minutes. During the tour of the facility, LPA conducted random call button checks, to which staff responded within 3 to 8 minutes.

.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Celine Rodriguez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 22-AS-20240503163000
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: BROOKDALE IRVINE
FACILITY NUMBER: 306002954
VISIT DATE: 06/11/2025
NARRATIVE
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It was alleged that staff spoke inappropriately towards resident. LPA Rodriguez conducted a total of 10 resident interviews of which all 10 resident interviews did not corroborate with the allegation. All 10 resident interviews disclosed that staff are friendly and nice. 1 out of 1 staff interview did not corroborate with the allegation by stating that there have been no complaints or issues about staff speaking inappropriately to a resident. Per record review, facility staff are required to complete training regarding on how to care for residents and on personal rights and it was verified that if staff are not trained on the topic of properly caring for residents, then staff are not allowed to be on the floor until training has been completed.

It was alleged that staff are not providing adequate food service to resident. LPA Rodriguez conducted a total of 10 resident interviews of which all 10 resident interviews did not corroborate with the allegation. Resident interviews stated that the food is good and “more than enough”. 1 out of 1 staff interview did not corroborate with the allegation by stating that although there is a set menu for the month, if a resident is requesting for a different meal, then the facility will accommodate them. Per record review, facility prepares meals with reduced sodium, fat and cholesterol. Per interview and record review, facility will tailor meals to residents in accordance with their physician report if it is stated that the resident has dietary needs and restrictions. Per observation, facility serves breakfast, lunch, dinner, and snacks, with choices of dairy, meat, grains, fruits, and vegetables.

It was alleged that staff did not meet resident's hygiene needs. LPA Rodriguez conducted a total of 10 resident interviews of which all 10 resident interviews did not corroborate with the allegation. 3 out of the 10 resident interviews specified that they are able to meet their own hygiene needs, but are aware that staff are available to assist if needed. 7 out of the 10 resident interviews stated that staff assist them with bathing and dressing, however stated that if they decline in wanting a shower that day, then staff will offer another opportunity to assist with bathing the next day. 1 out of 1 staff interview conducted, did not corroborate with the allegation by stating that staff will abide by the resident’s physician report and services plan to determine if a resident requires assistance with meeting their hygiene needs, but if a resident declines, then staff will not force a resident to shower or get dressed. Per record review, facility tracks which residents require assistance with their hygiene needs in a log, and if a resident declines, then the facility will document it. Per documentation review, resident 1 (R1) needed assistance with bathing, however declined all the time the staff attempted to assist.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Celine Rodriguez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20240503163000
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: BROOKDALE IRVINE
FACILITY NUMBER: 306002954
VISIT DATE: 06/11/2025
NARRATIVE
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It was alleged that staff are not meeting resident's needs. LPA Rodriguez conducted a total of 10 resident interviews of which all 10 resident interviews did not corroborate with the allegation. All 10 resident interviews verified that their needs are met, and discussed about how helpful the staff are, and confirmed that there were no health and safety concerns regarding the care being provided. 1 out of 1 staff interview did not corroborate with the allegation by stating that there have been no complaints with residents needs not being met. Per observations, LPA observed that residents were fed, clean, content and safe.

It was alleged that staff did not safeguard resident's personal belongings. LPA Rodriguez conducted a total of 10 resident interviews, and 1 staff interview of which all 11 interviews did not corroborate with the allegation by stating that residents are responsible for their own belongings. Per record review, residents are informed upon admission that they are responsible for their own belongings, and if a resident would like for staff to safeguard their personal belongings, then they must sign a form.

Based on LPA’s interviews which were conducted, review of documents obtained, and observations, LPA is unable to ascertain if the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed UNSUBSTANTIATED.

An exit interview was conducted with BOM Belanger.

A copy of this report was explained and provided during the visit.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Celine Rodriguez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3