BROOKDALE GARDEN GROVE

Official classification

Type B

Official code

87466

Regulation authority

CCR

What the official deficiency says

The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs…the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement is not met as evidence by: Based on the documents reviewed during the investigation, the facility did not ensure that the resident was reassessed despite multiple falls. There was no evidence that post-fall evaluations were conducted following R1’s repeated falls, nor that appropriate interventions or a fall prevention plan were implemented or documented. This condition poses a potential health and safety risk to residents in care.

Official plan of correction

As a plan of correction, the facility will also ensure that all residents who experience frequent falls are reassessed, and that appropriate fall prevention plans are developed and implemented in accordance with the facility’s Fall Management and Recovery Policy. In addition, the Administrator will review the cited regulation and submit a written statement to LPA Lee acknowledging understanding and compliance with the regulation due by 05/22/2026 end of day at 5:00 PM.

Deadline recorded: May 22, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

87464(f)(1) Basic Services (f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not met as evidence by Based on the documents reviewed during the investigation, the facility did not ensure that R1 received appropriate care and supervision despite experiencing multiple falls, which resulted in injuries, including two rib fractures. This poses a potential health and safety risk for residents in care.

Official plan of correction

As a plan of correction (POC), the Administrator will review the cited regulation and submit a written statement to LPA Lee acknowledging understanding and compliance with the regulation due by 05/22/2026 end of day at 5:00 PM.

Deadline recorded: May 22, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (a)… (4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by :Based on interviews and documents, the licensee did not ensure R1 received assistance with medications by not giving R1 their Furosemide on multiple days and giving R1 triple their prescribed dose on two days resulting in hospitalization, which poses an immediate health risk to persons in care. CIVIL PENALTY ASSESSED.

Official plan of correction

Licensee stated that they will retrain staff on medication administration and submit proof to LPA by POC due date.

Deadline recorded: Apr 17, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(3)

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities (a) … (3) To be free from punishment, humiliation, intimidation, abuse… This requirement was not met as evidenced by: Based on observation and interviews, the licensee did not ensure R1 was free from abuse when S1 and S2 forced care on R1 resulting in bruises, which poses an immediate personal rights risk to persons in care. CIVIL PENALTY ASSESSED.

Official plan of correction

The licensee has already investigated the situation and terminated the staff involved. Licensee stated they will submit their training records on resident refusals and resident rights to LPA by POC due date.

Deadline recorded: Dec 31, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(D)

Regulation authority

CCR

What the official deficiency says

87211 .. (a) … (1) A written report shall be submitted to … the person responsible for the resident within seven days of... (D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse …This requirement was not met as evidenced by: Based on documents and interviews, the licensee did not ensure R1’s responsible party received a written notification of R1’s rough handling by staff resulting in bruises, which poses a potential personal rights risk to persons in care.

Official plan of correction

The licensee stated they will review section 87211 and submit a plan to ensure incidents are properly reported to LPA by POC due date.

Deadline recorded: Jan 27, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(B)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (a) … (1) A written report shall be submitted to the licensing agency … within seven days of the occurrence of … (B) Any serious injury… This requirement was not met as evidenced by: Based on documents and admission, the licensee did not ensure R1’s hospitalization on September 5, 2025, was reported to licensing, which poses a potential safety risk to persons in care. CIVIL PENALTY ASSESSED.

Official plan of correction

Licensee stated that they will retrain staff on reporting requirements and submit proof to LPA by POC due date.

Deadline recorded: Oct 21, 2025. 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

87303 Maintenance and Operation (a) 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 in one out of twelve units inspected which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/05/2025 Plan of Correction Ceiling panel with mold removed and replaced during the visit. ED stated that the pipe in R1's room will be repaired by POC due date.

Official classification

Type B

Official code

87211(a)(1)(B)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (a) … (1) A written report shall be submitted to the licensing agency … within seven days of the occurrence of … (B) Any serious injury… This requirement was not met as evidenced by: Based on documents and admission, the licensee did not ensure R1’s fall on February 1, 2025, was reported to licensing, which poses a potential safety risk to persons in care.

Official plan of correction

Licensee stated that they will retrain staff on reporting requirements and submit proof to LPA by POC due date.

Deadline recorded: Mar 17, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87207

Regulation authority

CCR

What the official deficiency says

87207 False Claims. No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility. This regulation was not met as evidence by: Based on interviews conducted and records reviewed the Physician report dated 02/11/24 was not filled out by Scan's Nurse Parctitioner as Nurse Practitoner was not working on 02/11/24. This poses an immediately risk to resident’s health and safety.

Official plan of correction

Licensee agrees to read regulation and sign a statement of understanding and forward proof to LPA by POC due date.

Deadline recorded: Feb 14, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468(a)

Regulation authority

CCR

What the official deficiency says

87468(a) Personal Rights. Residents in residential care facilities for the elderly shall have personal rights which include, but are not limited to, those listed in Sections 87468.1, Personal Rights of Residents in All Facilities, and 87468.2, Additional Personal Rights of Residents in Privately Operated Facilities, as applicable to the facility. This regulation was not met as evidence by: Based on interviews conducted and records reviewed the facility did not communicate with R1's Authorized Representative prior to placing R1 in Memory Care. CONT...

Official plan of correction

Licensee agrees to read regulation and sign a statement of understanding, provide in-service training and forward proof to LPA by POC due date. Per Physician report dated 02/12/24, R1 does not have a diagnosis of Dementia and is able to leave the facility unassisted.

Deadline recorded: Feb 20, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87506(c)(1)

Regulation authority

CCR

What the official deficiency says

(c)All information and records obtained from or regarding residents shall be confidential. (1)...The licensee and all employees shall reveal or make available confidential information only upon the resident's written consent or that of his designated representative. This requirement was not met as evidence by: the facility did not provide R1's records for March 2024. This poses a potential risk to persons in care.

Official plan of correction

Licensee to provide R1's records to their Authorized Representative. Licensee to email POC to LPA by POC due date.

Deadline recorded: Nov 29, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87467(3)

Regulation authority

CCR

What the official deficiency says

Resident Participation in Decisionmaking (3)The licensee shall arrange a meeting with the resident and appropriate individuals identified in Section 87467(a)(1) to review and revise the written record as specified, when there is a significant change in the resident’s condition, or once every 12 months, whichever occurs first. This requirement was not met as evidence by the facility not arranging a meeting with R1 and their Authorized Representative prior to placing R1 in Memory Care. This poses a potential risk to persons in care.

Official plan of correction

Licensee to read and sign a statement of understanding. Licensee to email a copy to LPA by POC due date.

Deadline recorded: Nov 29, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(a)(7)

Regulation authority

CCR

What the official deficiency says

Additional Personal Rights of Residents in Privately Operated Facilities (a)(7) To fully participate in planning their care, including the right to attend and participate in meetings or communications regarding care and services to be provided, according to Health and Safety Code section 1569.80 and involve persons of their choice in this planning. This requirement was not met as evidence by: On 02/10/24 R1 had a tele medicine visit by a Provider from Senior Doc.; however, R1's provider was from Scan Health Plan. This poses a potential risk to persons in care.

Official plan of correction

Licensee to read and sign a statement of understanding. Licensee to email a copy to LPA by POC due date.

Deadline recorded: Nov 29, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(e)(3)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (3) Taps delivering water at 125 degree F (52 degrees C) or above shall be prominently identified by warning signs. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the faucets in rooms 103, 104, 115, and 243 tested at 126, 133, 124, and 129 degrees F, respectively, and rooms 103, 104, and 115 are in memory care, which poses an immediate safety risk to persons in care. During the inspection, the licensee adjusted the temperature and LPA confirmed.

Official plan of correction

POC Due Date: 08/10/2024 Plan of Correction Licensee stated they will begin conducting regular water temperature checks and will submit proof to LPA by POC due date.

Official classification

Type B

Official code

87468.2(a)(16)

Regulation authority

CCR

What the official deficiency says

87468.2(a)(16):Additional Personal Rights of Residents in Privately Operated Facilities (a)... residents...shall have...:(16) To written notice of any room changes at least 30 days in advance unless...agreed to...to fill a vacant bed, or...due to an emergency. This requirement was not met as evidenced by: The licensee failed to ensure this additional personal right was afforded to R1. Based on interviews and file review, the facility did not provide written notice to R1’s responsible party within 30 days of moving R1 to memory care unit. This poses a potential risk to residents in care.

Official plan of correction

AD stated the facility will submit a statement of understanding of the regulation cited and will provide in service training to all staff and provide proof to CCL by POC due date of 1/25/2024.

Deadline recorded: Jun 25, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

80072(a)(2)(3)

Regulation authority

CCR

What the official deficiency says

80072:Personal Rights(a)each client shall have personal rights which include... (2) To be accorded safe, healthful and comfortable accommodations,...to meet his/her needs.(3)To be free from corporal or unusual punishment, infliction of pain, humiliation, CONTINUED... CONTintimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature...This requirement was not met as evidenced by: The facility did not provide the resident and responsible party with a 30 day notice, and did not communicate with Authorized representative prior CONT...

Official plan of correction

AD Jeri Miles and HWD Brisseth Rivera agreed to read and understand CCR 80072, provide inservice to facility staff and submit proof of understanding to CCLD by 6/25/2024. to placing the resident in memory care. Although, the facility was attempting to ensure R1s Health and Safety by placing R1 in memory care unit, the facility attempted to substitute R1’s supervision needed to meet R1s need and provide necessary supervision. This poses a potential risk to residents in care.

Deadline recorded: Jun 26, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

87464(f)(1):Basic Services shall at a minimum include: (1) Care and Supervision as defined in Section 87101(c)(3) and Health & Safety Code 1569.2(C) " care and supervision means the facility responsibility for or provides or promises in future, ongoing assistance with activities CONT... assistance with activities of daily living without which the resident's physical, mental, health & safety, or welfare would be endangered. This requirement is not met as evidenced by the complaint investigation:The facility did not provide the resident and responsible party with a 30 day notice, CONT

Official plan of correction

AD Miles agreed to provide in-service training to facility staff regarding care and supervision and submit proof of udnerstading of CCR 87464 by POC due date of 6/25/2024. In addition, HWD Rivera indicated desire to enroll in AD certificate course to learn Title 22. and did not communicate with Authorized representative prior to placing the resident in delayed egress memory care unit. Although, the facility was attempting to ensure R1s Health and Safety by placing R1 in delayed egress memory care unit, the facility attempted to substitute R1’s supervision needed to meet R1s need and provide necessary supervision.This poses a potential risk to the residents in care.

Deadline recorded: Jun 24, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87507(f)

Regulation authority

CCR

What the official deficiency says

87507 Admission Agreement (f) " The licensee shall comply with all applicable terms and conditions set forth in the admission agreement... " This requirement was not met as evidenced by: Based on interviews and record review, facility did not adhere to the admission agreement pertaining to refunds which poses a potential Personal Rights risk to persons in care.

Official plan of correction

Executive Director stated they will issue a refund to R1's responsbile party, and to submit an Acknowledgement of Understanding for the said deficiency to LPA via email by POC due date.

Deadline recorded: Apr 30, 2024. A deadline is not proof that correction was completed.