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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 567610013
Report Date: 11/19/2024
Date Signed: 11/19/2024 04:43:30 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/13/2024 and conducted by Evaluator Valeria Conway
COMPLAINT CONTROL NUMBER: 29-AS-20241113160724
FACILITY NAME:BROOKHAVEN AL AT LEXINGTONFACILITY NUMBER:
567610013
ADMINISTRATOR:ATAKEEVA, GULIRAFACILITY TYPE:
740
ADDRESS:1462 LEXINGTON CTTELEPHONE:
(805) 586-4020
CITY:CAMARILLOSTATE: CAZIP CODE:
93010
CAPACITY:6CENSUS: 4DATE:
11/19/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Gulira "Gigi" AtakeevaTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Staff interfere with resident visits
Staff prohibit the resident from using a video device in their personal space
Resident sustained unexplained injuries while in care
Residents are isolated in their rooms by staff
Staff are unable to communicate with residents due to a language barrier
Staff do not ensure that resident's needs are met
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Valeria Conway conducted an initial 10-day complaint visit to the above facility. Upon arrival, LPA met with Gulira "Gigi" Atakeeva and the reason for the visit was explained. Entrance interview conducted.

During today’s visit, between 10:20 A.M. and 2:30 P.M., LPA interviewed Administrator, hospice nurse, residents, family members and two (2) staff members. The Reporting Party (RP) was anonymous therefore, the LPA was unable to obtain additional information regarding the allegations. Also, during the visit, LPA conducted a resident file review at 12:30 P.M., and obtained copies of pertinent documents relevant to the investigation.

Continued on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024
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 5
Control Number 29-AS-20241113160724
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: BROOKHAVEN AL AT LEXINGTON
FACILITY NUMBER: 567610013
VISIT DATE: 11/19/2024
NARRATIVE
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Continued from LIC 9099

It was alleged that facility staff are unable to communicate with resident due to a language barrier. It is the Reporting Party (RP) concern that staff does not speak English. Information gathered during the course of the investigation reflected that Staff #1 (S1) and Staff 2 (S2) can speak limited English proficiency. However, family members reported no concerns communicating with staff members, also despite the staff’s basic English skills, any concerns or issues can be promptly addressed by texting or calling the Administrator. Family members emphasized that the Administrator is responsive and ensures that issues are resolved in a timely manner. Additionally, S1 and S2 confirmed that if they have any questions or need clarification, they contact the Administrator directly via phone. Based on the above information gathered although the allegations may be valid, there is insufficient evidence to support the allegation or that a violation occurred; therefore, the allegations “Staff are unable to communicate with residents due to a language barrier” is deemed unsubstantiated at this time.

It was alleged that facility staff interfere with resident visits and residents are isolated in their rooms by staff. It is the Reporting Party (RP) concern that staff “hovers” over residents and residents are always in their rooms. Information gathered during the course of the investigation reflected that staff don’t linger over residents or their visitors during visitation. While at the facility today, the LPA observed multiple family visits. At 10:25 A.M. a family member was visiting Resident 1 (R1). R1 was seated in a recliner in the common area. During the visit, LPA did not observe any staff members nearby or interrupting their conversation. At 12:15 P.M., LPA observed Resident #2 (R2) having lunch with a visitor at the dining table. Staff were present in the dining area, assisting residents, but did not interfere with the visit. At 12:30 P.M. LPA observed R2 and their visitor outside in the backyard talking for approximately one (1) hour without staff presence or interruption. Additionally, LPA observed residents freely utilizing the common areas in the morning after breakfast and during lunch. Based on the above information gathered although the allegations may be valid, there is insufficient evidence to support the allegation or that a violation occurred; therefore, the allegations “staff interfere with resident visits” and “Residents are isolated in their rooms by staff” are deemed unsubstantiated at this time.
Continued on LIC 9099-C
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 29-AS-20241113160724
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: BROOKHAVEN AL AT LEXINGTON
FACILITY NUMBER: 567610013
VISIT DATE: 11/19/2024
NARRATIVE
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Continued from LIC 9099-C

It was alleged that facility staff prohibit the resident from using a video device in their personal space. It is the Reporting Party (RP) concern that staff are not allowing resident to have a smart device in their room. Information gathered during the course of the investigation reflected that Administrator did not prohibit family members from installing smart devices in resident’s room. The Administrator stated that it is the responsibility of family members to purchase and set up such devices, if desired. The facility provides free internet access to both residents and visitors. Administrator supports family decisions regarding the use of such technology to keep them connected. Interviews revealed a resident had a cellphone to FaceTime family members, however, due to their dementia diagnosis, they were unable to effectively use the device. Additionally, a family member reported that their loved one previously had an “Alexa” device in their room. However, the device was removed by the family because the resident, who is under hospice care and has advanced Alzheimer’s disease and confusion, would become agitated upon hearing voices from the device without understanding their source. Based on the above information gathered although the allegations may be valid, there is insufficient evidence to support the allegation or that a violation occurred; therefore, the allegations “staff interfere with resident visits and residents are isolated in their rooms by staff” is deemed unsubstantiated at this time.


It was alleged that resident sustained unexplained injuries while in care. It is the Reporting Party (RP) concern that staff are neglecting the residents while in care. During today’s visit, family members expressed no concerns regarding the care of their loved ones nor did they believe their loved ones are being neglected or abused. Staff interviews indicated that residents are always supervised and handled with care. Staff reported that at least two (2) caregivers assist residents at all times to ensure their safety. Additionally, a hospice care nurse who provides care for three (3) out of four (4) residents at this facility, stated that residents at this age are very fragile and can bruise easily.

Continued on LIC 9099-C

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 29-AS-20241113160724
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: BROOKHAVEN AL AT LEXINGTON
FACILITY NUMBER: 567610013
VISIT DATE: 11/19/2024
NARRATIVE
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Continued from LIC 9099-C

However, the nurse emphasized that none of the residents they care for -who are seen twice a week every week- have had any unexplained bruises. The hospice nurse also confirmed that if any abuse were to occur in the facility, they would immediately report it to the proper authorities. Interviews conducted and information gathered during the course of the investigation revealed no evidence of abuse or neglect. Based on the above information gathered although the allegations may be valid, there is insufficient evidence to support the allegation or that a violation occurred; therefore, the allegations “staff interfere with resident visits and residents are isolated in their rooms by staff” is deemed unsubstantiated at this time.

It was alleged that staff do not ensure that resident's needs are met. It is the Reporting Party (RP) concern that staff do ensure toileting needs are being met. Interviews conducted and information gathered during the course of the investigation revealed that residents are being properly care for and kept clean at all times. Interviews with Staff #1 (S)1, Staff #2 (S2) and hospice nurse indicated that residents are bathed multiple times a week. S1 and S2 stated that residents receive regular showers twice a week and have diaper changes three (3) times a day or as needed. They further explained that if a resident has an accident or becomes dirty, they are promptly cleaned to prevent skin irritation or breakage. This may involve wiping, changing, or even showering the resident, depending on the situation. A review of shower logs confirmed that residents are being showered regularly. Interviews with family members revealed no concerns regarding resident’s toileting or hygiene needs. Family members expressed satisfaction with the care provided at the facility, describing the administrator and staff as kind and attentive to residents’ needs.



Continued on LIC 9099-C
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 29-AS-20241113160724
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: BROOKHAVEN AL AT LEXINGTON
FACILITY NUMBER: 567610013
VISIT DATE: 11/19/2024
NARRATIVE
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Continued from LIC 9099-C

Family member stated that facility staff have never refused them the opportunity to be present while a resident’s diaper is being changed. However, they noted that in most instances, unless the resident specifically wants them to remain present, they will wait outside to respect the resident’s privacy. During the LPA’s visit, no unpleasant odors were noticed among the residents, and the facility was observed to be clean and well-maintained. Based on the above information gathered although the allegations may be valid, there is insufficient evidence to support the allegation or that a violation occurred; therefore, the allegations “staff interfere with resident visits and residents are isolated in their rooms by staff” is deemed unsubstantiated at this time.

Exit interview conducted/ No citations issued/ A copy of report provided.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5