<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306002962
Report Date: 10/28/2025
Date Signed: 10/28/2025 05:08:15 PM

Substantiated


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
10/03/2025 and conducted by Evaluator Michael Tea
COMPLAINT CONTROL NUMBER: 22-AS-20251003170854
FACILITY NAME:BROOKDALE BROOKHURSTFACILITY NUMBER:
306002962
ADMINISTRATOR:JOHN GOODWINFACILITY TYPE:
740
ADDRESS:15302 BROOKHURST STTELEPHONE:
(714) 775-6775
CITY:WESTMINSTERSTATE: CAZIP CODE:
92683
CAPACITY:164CENSUS: 114DATE:
10/28/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:John Goodwin, Suzette PaigeTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
- Staff did not seek medical attention for a resident in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On this day, Licensing Program Analyst (LPA) Michael Tea made an unannounced visit to conclude and deliver findings for a complaint investigation. LPA Tea was greeted and granted entry by facility staff and explained the reason for the visit. Executive Director (ED) John Goodwin arrived shortly to assist with the visit.

The Department received a complaint on October 3, 2025, and LPA Tea conducted the initial 10-day visit on October 9, 2025. LPA Tea spoke to facility staff and reviewed and collected pertinent documents and information.

It was alleged that facility staff failed to seek timely medical attention for a resident in care. The investigation determined the following: Photographic evidence provided to the Department depicted Resident 1 (R1) with significant bruising along the shoulder area and lighter bruising above the left eyebrow extending from the
(Complaint Investigation continued on LIC9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2025
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-20251003170854
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 BROOKHURST
FACILITY NUMBER: 306002962
VISIT DATE: 10/28/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
hairline. A police report obtained by the Department included a witness statement describing that upon touching the bruised area of R1’s shoulder, distinct welts could be felt. The witness indicated that the bruising pattern appeared consistent with the shape of a hand, suggesting that R1’s shoulder may have been forcefully grabbed or yanked. The photographs and police report collectively demonstrate the presence of extensive and severe bruising that, based on its visibility, should reasonably have been observed earlier in the day. Accordingly, medical evaluation should have been sought immediately upon discovery.

Interviews conducted by LPA Tea with current facility staff, former staff members, and witnesses revealed that six out of nine interviewees confirmed the bruising was ultimately identified by R1’s daughter in the evening, prompting the facility to seek medical attention at that time. One staff member reported that earlier that morning, a caregiver had informed a medtech about the bruising; however, the information was not relayed to facility management. Another staff member stated that while they had noticed the lighter facial bruising, they were unaware of the more severe bruising on R1’s body. That staff member further confirmed that the facial bruising had been reported to management.

Despite these internal reports, there is no evidence indicating that timely medical attention was sought by facility staff prior to the discovery by R1’s daughter later that evening. It was not until R1’s daughter’s discovery of their bruising that R1 was transported to the hospital emergency department for evaluation. A witness confirmed that diagnostic imaging, including a CT scan and blood work, revealed no fractures or internal bleeding and serious or severe injuries.

Therefore, based on LPA Tea's observations, interviews conducted, and documents obtained, the allegation mentioned above has been determined to be SUBSTANTIATED, meaning the complaint allegation is valid and that a violation has occurred.

The following is being cited per California Code of Regulations Title 22 Division 6 Chapter 8.

An exit interview was conducted with Executive Director (ED) John Goodwin and Health & Wellness Director (HWD) Suzette Paige and a copy of this report and appeal rights were provided to the facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20251003170854
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 BROOKHURST
FACILITY NUMBER: 306002962
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/28/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/29/2025
Section Cited
CCR
87465(a)(1)
1
2
3
4
5
6
7
87465 Incidental Medical and Dental Care... The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents
This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Facility will sign a statement of understanding for the regulation cited and will conduct an inservice training about the regulation and reporting requirements in which they will send proof of POC to LPA by email by COB.
8
9
10
11
12
13
14
Based on documents obtained and interviews, the facility did not ensure R1 received proper assistance and medical care in a timely manner which poses an immediate health and safety risk to residents in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3