BROOKDALE MONROVIA

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in that LPA measured the water temperature readings in Room #s 106 (131.1 deg F), 109 (129.3 deg F), 134 (123.8 deg F), 218 (124.5 deg F) and 228 (131.5 deg F) which were not within the required 105 degrees F to 120 degrees Fahrenheit. This poses an immediate health, safety or personal rights risk to residents in care.

Official plan of correction

POC Due Date: 06/13/2026 Plan of Correction Executive Director shall immediately adjust water temperature. Executive Director to check water temperature at various different times throughout the day and maintain and submit a water temperature log to the LPA for the next 3 days to ensure that hot water temperature falls within 105 degrees F and 120 degrees F. Executive Director will provide a copy of the log to the department once water temperature falls within Title 22 guidelines..

Official classification

Type B

Official code

87211(a)(1)(D)

Regulation authority

CCR

What the official deficiency says

(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. (D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement is not met as evidenced by: Based on interviews and records review, the facility staff sent the LIC624 Unusual Incident Report to Licensing on 09/18/2025 for a physical altercation between Resident #1 (R1) and Resident #3 (R3) that occurred on 09/08/2025. LPA obtained facility Progress Notes which indicated that the staff had knowledge of the physical altercation between R1 and R3 on 09/08/2025. The facility failed to not report to licensing within seven days, per Title 22 reporting requirements. This poses a potential health and safety risk to persons in care.

Official plan of correction

Executive Director will ensure that Special Incident Reports and Reportable Incidents are sent to Licensing as required. Executive Director will ensure that all staff are re-trained in Reporting Requirements and provide all training materials and training signup sheets to the LPA by the POC due date.

Deadline recorded: Oct 16, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(f)

Regulation authority

CCR

What the official deficiency says

(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health. Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the Executive Director, Staff #2 (S2), Staff #5 (S5), and Staff #6 (S6’s) file did not have the valid Health Screening and TB test result in file which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/02/2025 Plan of Correction Licensee will send the Executive Director, Staff #2 (S2), Staff #5 (S5), and Staff #6 (S6’s) Health Screening and TB test result to the LPA by the POC due date.

Official classification

Type B

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

(1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview, record review, the Administrator did not comply with the section cited above in that (5) out of (6) staff files reviewed did not have a valid/current First aid/CPR training certificates on fil which poses/posed a potential health, safety or personal rights risk to residents in care.

Official plan of correction

POC Due Date: 08/27/2024 Plan of Correction Administrator will ensure that all staff have been provided with first aid training. Administrator scheduled the First aid/CPR training to multiple staff at the facility next week and shall submit the certificates of these (5) staff: S1/Dedearie Villanueva, S2/Tamaria Mcrae, S3/Kathryn Sandoval, S4/Carina Graham and S5/Dylaney Edinger to CCL/LPA by POC due date.

Official classification

Type A

Official code

87628(a)

Regulation authority

CCR

What the official deficiency says

87268 Diabetes (a) The licensee shall be permitted to accept or retain a resident who has diabetes if the resident is able to perform his/her own glucose testing (...) or has it administered by an appropriately skilled professional. The requirement is not met as evidenced by: Based on interview and record review conducted with residents and staff, LPA determined that R3 is getting their blood sugar level tested by S7. Additionally, R3's physician report indicates that R3 cannot test their own glucose levels, which poses an immediate risk for clients in care.

Official plan of correction

Administrator shall ensure that only appropriate skilled professionals administer medicaiton through injection or assist residents with glucose testing while in care. During record review and interviews, it was determined that R3 is not able to test her own glucose levels. (Cont.) Additionally it was revelaed that S7 does the glucose testing for R1 even though theyare not a skilled professional. Administrator to submit a written plan indicating how facility will meet regulation 87628 moving forward.

Deadline recorded: Sep 1, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above. Room #122 shower facet is loose which poses potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/20/2023 Plan of Correction Administrator will repair shower facet in room #122 and send proof to LPA by POC date.

Official classification

Type A

Official code

87303(e)(1)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above. Bathroom in first floor closer to reception desk had water temperature at 120.02 degrees F. Shower water in room 125 measured 98.1 degrees F. Room 234 water measured 121.1 degrees F which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/15/2023 Plan of Correction Administrator will adjust water temperature and send proof to LPA by POC date.

Official classification

Type A

Official code

Not listed

Regulation authority

Not listed

What the official deficiency says

Maintenance and Operation. Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). This requirement is not met as evidenced by: The hot water temperature in the rooms listed below were not in compliance with Title 22 Regulations: At 11:12am, Room #105 kitchen - measured at 124 degrees F. & bathroom - measured at 122.2 degrees F. At 11:19am, Room #131 kitchen - measured at 124.9 degrees F. & bathroom - measured at 123.1 degrees F. At 11:38am, Room #234 bathroom - measured at 123.1 degrees F. At 11:45am, Room 208 kitchen - measured at 121.2 degrees F. At 11:52am, Room #218 kitchen - measured at 98.5 degrees F., bathroom #1 - measured at 97.2 degrees F. & bathroom #2 - measured at 68.1 degrees F. This poses an immediate health and safety risk to persons in care.

Official plan of correction

and #218 (kitchen, bathroom #1 and bathroom #2). POC must be submitted to CCL by the POC due date.

Deadline recorded: Dec 10, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

Not listed

Regulation authority

Not listed

What the official deficiency says

Maintenance and Operation. The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: At 11:07am, LPAs observed the wall near the entrance of room #112 was in disrepair. There was a hole on the corner of the wall. At 11:12am, LPAs observed the kitchen top drawer (next to the sink) located in room #105 was in disrepair and would not open or close properly.

Deadline recorded: Dec 16, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

Not listed

Regulation authority

Not listed

What the official deficiency says

Maintenance and Operation. The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: At 12:04pm, LPAs observed the wooden fence located by the east walk way was in disrepair. The fence had broken pieces and was leaning forward (towards the facility). This poses a potential health and safety risk to persons in care.

Deadline recorded: Jan 10, 2022. A deadline is not proof that correction was completed.