Inspection Reports for Brookdale Central Whittier

The inspection was an unannounced complaint investigation visit triggered by allegations received on 2025-05-20 regarding facility temperature control and tripping hazards, among other complaints.

The investigation substantiated that some second-floor rooms were uncomfortably cold due to thermostat issues and that raised laminate flooring in the dining room posed a tripping hazard causing a resident fall and injury. Other allegations related to staff behavior, elevator repair, and room cleanliness were found unsubstantiated.

The complaint investigation was substantiated for allegations that the facility was not maintained at a comfortable temperature and was not free of tripping hazards, resulting in a resident fall with femur fracture and surgery. Other allegations regarding staff inappropriate behavior, elevator repair, and room cleanliness were unsubstantiated.

The visit was an unannounced complaint investigation to examine the allegation that the licensee did not follow a resident's admission agreement.

The investigation found that although the resident was billed for services, the licensee followed refund procedures and the admission agreement. There was insufficient evidence to corroborate the allegation, and the complaint was determined to be unsubstantiated.

The complaint alleged that resident R1 was billed for services not rendered, including deposits and automatic withdrawals from a shared bank account. Interviews and record reviews showed the resident moved in November 28, 2023 and moved out March 2, 2024. A credit refund of $16,499.02 was issued to the responsible party. The allegation was unsubstantiated due to insufficient evidence.

The inspection was an unannounced complaint investigation visit triggered by allegations received on 2025-05-12 regarding inadequate cleaning, odors, and pest infestation in a resident's room.

The investigation substantiated that staff did not ensure the resident's room was adequately cleaned, free from odors, or free from pests. The resident's room was found cluttered with hoarding, had a strong odor of pet feces and urine, and was infested with cockroaches. Pest control services were initiated after discovery of the infestation.

The complaint investigation was substantiated based on observations, interviews, and document reviews. Allegations included inadequate cleaning, odors from pet waste, and pest infestation in resident R1's room. Staff were unaware of the cockroach infestation until shortly before the investigation. Pest control services were arranged and ongoing.

The inspection was conducted as an unannounced complaint investigation regarding allegations that facility staff do not ensure the facility showers are clean and orderly.

The investigation substantiated the allegation that the second floor common shower was not properly maintained, with a non-operational fan inside the shower and tile grout needing deep cleaning. Staff and resident interviews, along with a tour, confirmed these issues.

The complaint alleged that the second floor common shower needed cleaning, had mildew, fans did not work properly, and the vanity was too large. The allegation was substantiated based on interviews and observations.

The visit was a Case Management - Incident inspection to follow up on a 3rd party SOC 341 Report of Suspected Dependent Elder Abuse related to financial abuse of a resident by social media contacts.

The investigation found that resident R1 had willfully gifted money to persons met via Facebook, and the facility failed to submit the required SOC 341 report to the licensing agency upon knowledge of the financial abuse. A citation was issued for this failure.

The visit was triggered by a complaint involving suspected financial abuse of resident R1 by social media 'friends'. The complaint was substantiated by findings that the resident was financially exploited and the facility failed to report the abuse to the licensing agency.

An unannounced complaint investigation visit was conducted regarding allegations that staff did not ensure a resident's room was adequately cleaned, free from odors, and free from pests.

The investigation found substantiated evidence of unsanitary conditions in resident R1's room, including clutter, dead and live cockroaches, pet feces and urine odors, and pest infestation. Staff were unaware of the infestation until recently, and pest control services were initiated during the visit.

The complaint investigation was substantiated based on observations, interviews, and photographic evidence confirming the allegations of inadequate cleaning, odors, and pest infestation in resident R1's room.

The inspection was an unannounced required 1-year visit to evaluate compliance with licensing requirements for the Residential Care For Elderly (RCFE) facility serving residents aged 60 and over.

The facility was found to have several deficiencies including water temperature exceeding the required range in some rooms, missing mattress pads in certain resident rooms, and uncovered food items in the refrigerator. Infection control supplies and operational requirements such as fire clearance and liability insurance were in place. The facility has a hospice waiver for 8 residents and provides care with 38 staff members.

Unannounced case management visit regarding the relocation of 22 residents from Brookdale Santa Monica Gardens to Brookdale Central Whittier due to mandatory evacuation orders from a Fire Advisory.

The relocated residents were found to have designated rooms with necessary supplies and medical equipment. Staffing and medication administration were maintained by staff from the original facility. The facility had sufficient food supplies and accommodations for all residents. No deficiencies or violations were noted.

The visit was an unannounced complaint investigation conducted in response to multiple allegations including failure to respond in writing to resident council concerns, lack of posting of 'Rights of Resident Councils', facility disrepair, and inadequate housekeeping services.

The investigation found no preponderance of evidence to substantiate the allegations. Resident council concerns were addressed verbally and in writing, 'Rights of Resident Councils' were posted prominently, the facility was observed to be in good repair, and housekeeping services were provided weekly as scheduled.

The complaint investigation was unsubstantiated for all allegations after interviews with residents and staff, physical inspection of the facility, and review of documentation.

An unannounced complaint investigation visit was conducted in response to an allegation that staff did not ensure a resident was provided transportation as agreed to in the Admission Agreement.

The investigation found that the facility did not have a staff bus driver for over six months, causing resident R1 to miss at least two necessary pre-surgery medical appointments in the past week and a total of six appointments in the last six months. Transportation arrangements with sister communities were inconsistent, and no contract was in place with home care agencies. The allegation was substantiated based on interviews, record reviews, and observations.

The complaint alleged that staff did not ensure transportation for resident R1 as agreed, causing missed medical appointments. The allegation was substantiated after investigation.

The inspection was an unannounced complaint investigation visit triggered by an allegation that facility staff were not maintaining laundry equipment in good repair.

The investigation confirmed that the 2nd floor Resident Laundry Room dryer and the basement washer were in disrepair for approximately 4 weeks, causing delays in residents' laundry routines and posing a potential health and safety risk. A new washer and dryer have been ordered and are expected to arrive soon.

The complaint was substantiated. The allegation was that the 2nd floor dryer was in disrepair, making loud noises that disturbed residents and delayed laundry. Staff and residents confirmed the issue, and observations corroborated the allegation.

The inspection was an unannounced required 1-year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools to evaluate compliance with regulatory requirements.

The inspection found deficiencies related to water temperature exceeding the allowed range in multiple resident rooms and food safety violations involving improper thawing and storage of food. Other areas such as infection control, staffing, resident records, and physical plant safety were reviewed with some pending corrections noted.

The visit was an unannounced complaint investigation conducted in response to allegations that staff placed a resident on hospice against their wishes and that staff were not following a resident's legal documentation.

The investigation found that the resident was placed in hospice care by their legally appointed Power of Attorney (POA) in accordance with the resident's Advance Health Care Directive and POLST orders. The facility followed the legal documents and POA's decisions. The allegations were determined to be unsubstantiated due to lack of evidence proving violations.

The complaint alleged that staff placed a resident on hospice against their wishes and did not follow the resident's legal documentation. The investigation included interviews, record reviews, and a facility tour. It was found that the POA made the hospice care decision and the facility adhered to all legal documents. The allegations were unsubstantiated.

The inspection was an unannounced complaint investigation visit triggered by allegations received on 2023-12-13 regarding inadequate incontinence care, grooming neglect, unclean linens, and hazardous items accessible to a resident.

The investigation substantiated multiple allegations including failure to meet incontinence care needs, neglect of grooming, failure to provide clean linens, and failure to remove hazardous items from a resident's bed. Photographic evidence and interviews supported these findings, indicating risks to resident health, safety, and personal rights.

The complaint investigation was substantiated. Allegations included staff not meeting incontinence care needs, neglecting grooming, not providing clean linens, and failing to make hazardous items inaccessible to the resident. Evidence included interviews with residents and staff, photographs, and observations during the visit.

The visit was an unannounced complaint investigation regarding an allegation that a resident sustained a fracture while in care.

The investigation found insufficient evidence to determine if the facility caregiver caused the resident's fracture. Medical records showed no evidence of suspected abuse or neglect. Therefore, the allegation was found to be unsubstantiated.

The complaint alleged that a resident was rough handled by a caregiver resulting in a fracture. After interviews with staff, administrator, and review of medical records, there was no sufficient evidence to support the allegation. The finding was unsubstantiated.

The visit was an unannounced complaint investigation regarding an allegation that the facility did not provide a refund to a resident's authorized representative.

The investigation found that although the allegation may have happened or is valid, there was not a preponderance of evidence to prove the alleged violation did or did not occur, resulting in the allegation being unsubstantiated. A refund was issued as a good faith gesture, exceeding the expected amount.

Allegation: Facility did not provide refund to representative. The complaint involved a resident who never physically moved in, and the authorized representative claimed the refund was not properly issued. After review, the refund was issued as a good faith gesture, and no financial discrepancies were found. The allegation was unsubstantiated.

The inspection visit was conducted in response to a complaint alleging that the facility evicted a resident without assisting with alternative housing and care options.

The investigation found that the facility did provide assistance to the resident in finding new housing, including help with phone calls and involvement of the resident's nurse practitioner. The allegation was determined to be unsubstantiated due to lack of preponderance of evidence.

The complaint alleged that the facility evicted resident #1 without assisting with alternative housing and care options. The investigation included interviews with the Executive Director, staff, and the resident, as well as review of documents. The allegation was found unsubstantiated.

The inspection was an unannounced required 1-year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools to evaluate compliance with regulatory requirements.

The facility was inspected across multiple domains including infection control, operational requirements, physical plant safety, staffing, personnel records, resident records, planned activities, food service, incident medical and dental, disaster preparedness, and residents with special health needs. Several deficiencies were cited related to water temperature regulation, facility maintenance, staff training, and medication administration.

The visit was conducted as a complaint investigation following allegations that staff failed to meet residents' hygiene needs, failed to give resident medication timely, and staff members spoke inappropriately to residents.

The investigation substantiated the allegation that a staff member (S1) spoke inappropriately and was rough and aggressive towards residents, resulting in disciplinary actions and termination. The allegations regarding failure to meet hygiene needs and timely medication administration were unsubstantiated due to lack of preponderance of evidence.

The complaint investigation was unannounced and conducted following a complaint received on 04/28/2020. Allegations included staff failing to meet residents' hygiene needs, failing to give medication timely, and inappropriate staff behavior. The allegation of inappropriate staff behavior was substantiated; the others were unsubstantiated.

The inspection was an unannounced complaint investigation visit triggered by allegations received on 04/22/2021 regarding resident shower assistance, lack of grab bars in showers, untimely cleaning of soiled towels, and safeguarding of resident belongings.

The investigation found insufficient evidence to substantiate the allegations. Residents requiring shower assistance were accommodated per schedule, grab bars were present in showers, laundry services including soiled towels were provided weekly and handled appropriately, and resident belongings were safeguarded. The allegations were therefore unsubstantiated.

The complaint investigation was unsubstantiated. Allegations included lack of shower assistance, absence of grab bars, untimely cleaning of soiled towels, and failure to safeguard resident belongings. Interviews with staff and residents, document reviews, and observations did not support the allegations.

The inspection was an unannounced complaint investigation visit triggered by an allegation that a resident sustained a fracture while in care.

The investigation found no sufficient evidence to substantiate the allegation of abuse or neglect related to the resident's fracture. The facility was found clean and in good repair, and no immediate health or safety concerns were noted. The allegation was determined to be unsubstantiated.

The complaint alleged that a resident sustained a fracture while in care. The investigation included interviews with staff, residents, the resident's relative, and review of medical and hospital records. It was found that the resident had ongoing medical issues and it was unclear if the fracture occurred at the facility or elsewhere. No evidence of abuse or neglect was found, and the allegation was unsubstantiated.

Unannounced case management visit to cite deficiencies related to a complaint investigation regarding resident pain and facility response.

The investigation found that resident R1 complained of right-side and chest pain which was not promptly addressed by the facility, resulting in a delayed hospital visit where R1 was diagnosed with a rib fracture and elevated potassium level. Deficiencies were cited for failure to observe and document changes in resident condition and for the administrator's failure to follow up on the resident's condition.

Complaint investigation related to resident R1's pain complaints and facility's delayed medical response. The complaint was accepted by the CCL IB investigation Unit and included interviews with resident's relative, staff, residents, administrator, physical therapist, and review of hospital and police reports. The complaint was substantiated with cited deficiencies.

An unannounced complaint investigation visit was conducted to investigate an allegation of unlawful eviction of a resident.

The investigation found that the resident had a long history of alcohol abuse violating the facility's residency agreement, but there was insufficient evidence to substantiate the allegation of unlawful eviction. The resident was still residing at the facility with a verbal extension to move out.

The allegation was that on 6/9/22 a resident was issued a 30-day eviction notice for heavy alcohol drinking in their private room. The resident had multiple incident reports related to alcohol intoxication and posed health and safety risks. Staff denied the allegation of unlawful eviction. The allegation was unsubstantiated due to lack of preponderance of evidence.

An unannounced required 1-year visit focusing on COVID-19 Infection Control Practices was conducted to evaluate the facility's compliance with health and safety regulations.

The inspection found plumbing issues in rooms #211 and #201, broken vertical blinds in room #231, and medication errors involving missing and undocumented medications for residents. COVID-19 infection control practices were observed and found to be in place, including signage and staff mask usage.

The visit was an unannounced complaint investigation conducted in response to allegations that staff did not inform the authorized representative of a resident's fall resulting in injury and that staff would not itemize the resident's bill.

The investigation substantiated that a resident sustained two falls, one of which was not reported to the authorized representative or Community Care Licensing due to incorrect contact information. Additionally, the facility delayed providing an itemized bill to the resident's authorized representative, and the Residency Agreement did not list additional personal service fees that were charged.

The complaint was substantiated. Staff failed to inform the authorized representative of a resident's fall on 10/10/21 resulting in bruising and scrapes. The authorized representative was not notified due to incorrect phone numbers. The second fall on 10/27/21 was properly reported. Staff also delayed providing an itemized bill to the authorized representative, who only received it after multiple requests and an in-person visit.

The visit was an unannounced complaint investigation conducted in response to an allegation that staff failed to follow an authorized representative's directive to reject flu shot administration.

Based on document review and interviews, the allegation was found to be unsubstantiated due to insufficient evidence to prove the alleged violation occurred. Resident (R1) signed the flu shot consent form thinking it was for the COVID-19 booster shot, and staff stated the resident willingly accepted the flu shot.

The complaint alleged that staff failed to follow the authorized representative's directive to reject flu shot administration for resident (R1). The investigation found insufficient evidence to substantiate the allegation, concluding it was unsubstantiated.

The visit was an unannounced complaint investigation triggered by a complaint received on 2021-01-07 alleging that the facility was in disrepair.

The investigation substantiated the allegation that the facility was in disrepair, with multiple plumbing issues and maintenance problems reported by residents and confirmed by inspections. The facility had ongoing plumbing problems since late 2020, including clogged toilets, broken fixtures, and a temporarily closed main entrance due to major plumbing repairs.

The complaint was substantiated based on observations and interviews. Residents reported plumbing and maintenance issues since late 2020, including clogged toilets and broken fixtures. Staff confirmed plumbing problems affecting laundry areas and other parts of the facility. Repairs were ongoing as of the inspection date.

The visit was an unannounced complaint investigation triggered by an allegation that the facility does not provide residents with an adequate quantity of food.

Based on observations, interviews, and meal service reviews, the facility provides approved measured servings of food according to Brookdale Menu Manager guidelines, with residents able to request second servings or alternative menu items. The allegation was found to be unsubstantiated due to insufficient evidence.

The complaint alleged that the facility does not provide residents with an adequate quantity of food. After investigation including virtual and in-person tours, interviews with residents and staff, and meal observations, the allegation was determined to be unsubstantiated.

An unannounced required 1-year visit focusing on COVID-19 Infection Control Practices was conducted to evaluate compliance with health and safety regulations.

The inspection found that five out of fourteen resident rooms lacked hand sanitizer, and five out of eight reviewed resident medication records showed missing medications. COVID-19 infection control practices were generally observed, including mask use by staff and social distancing during dining.

An unannounced complaint investigation was conducted following allegations that staff left residents in soiled clothing for extended periods, residents' rooms smelled like urine, and residents were denied incontinence products.

The investigation found no substantiation for the allegations. Residents and staff interviews indicated residents were changed frequently, rooms did not have urine odors, and no residents were denied incontinence products. No deficiencies were cited.

The complaint investigation was unsubstantiated. Allegations included staff leaving residents in soiled clothing, rooms smelling like urine, and denial of incontinence products. Interviews and records review did not support these claims.

This complaint investigation was conducted in response to a complaint received on 03/18/2020 alleging staff intimidation, threats of eviction, mishandling of resident belongings and medication, improper feeding, and other concerns at Brookdale Central Whittier facility.

The investigation included interviews with residents, staff, and the administrator, and review of records. All allegations were denied by staff and residents, with no sufficient evidence found to substantiate the claims. The complaint was determined to be unsubstantiated.

The complaint investigation was unsubstantiated due to lack of sufficient evidence to prove the alleged violations occurred. Allegations included staff intimidation, threats of eviction, mishandling of personal belongings and medication, and improper feeding.