Brookdale Ocean House

***This report supersedes the original report delivered on 5/21/2025. On 7/3/2025 at 8:50AM, the LPA arrived at the facility to deliver the corrected 9099, providing clarification on the original report issued on 05/21/2025. *** On 5/21/2025, at 9:19 AM Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to conduct and deliver findings for the alleged allegations. LPA identified herself and met Helen Lee-Administrator who was informed of the purpose of the visit. The investigation consisted of the following: On 5/21/2025 at 9:25 PM, LPA Allen requested and obtained the personnel and resident roster, unusual incident reports (UIRs), and observations of the internal incident log/notes. Additionally, LPA conducted interviews with twelve (12) residents and nine (9) staff members, as well as observations of residents and staff interactions during the visit. UnsubstantiatedRead the full finding— CDSS inspection report, July 3, 2025 · control 11-AS-20250512120417

On 5/21/2025, at 9:19 AM Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to conducted and deliver findings for the alleged allegations. LPA identified herself and met Helen Lee-Administrator who was informed of the purpose of the visit. The investigation consisted of the following: On 5/21/2025 at 9:25 PM, LPA Allen requested and obtained the personnel and resident roster, unusual incident reports (UIRs), and observations of the internal incident log/notes. Additionally, LPA conducted interviews with twelve (12) residents and nine (9) staff members, as well as observed resident and staff interactions during the visit. Investigation revealed the following: UnsubstantiatedRead the full finding— CDSS inspection report, May 21, 2025 · control 11-AS-20250512120417

The investigation consisted of the following: On 03/14/2025, Licensing Program Analysts (LPAs) Regina Cloyd and Jose Anguiano conducted a complaint investigation at the above facility to address the following allegations. LPAs met with Business Office Manager Esmeralda Ornelas and Sales Manager Pro Jenn O'Brien Chavez and explained the purpose of the visit. Executive Director Helen Lee joined us later. LPAs conducted resident and staff interviews, toured the kitchen and dining area, and collected facility and staff records. On 03/27/2025, LPA Cloyd conducted a subsequent complaint to deliver findings. LPA met with Business Office Manager Esmeralda Ornelas and Executive Director Helen Lee. Allegation: Regarding the allegation "Facility staff do not prepare meals in a sanitary manner,” it is being alleged that kitchen staff often do not wash or sanitize their hands before cooking and frequently do not wear gloves while handling raw food and serving the residents. Continue to LIC9099-C. URead the full finding— CDSS inspection report, March 27, 2025 · control 11-AS-20250307153652

The investigation consisted of the following: On 10/31/2024, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced complaint investigation at the above facility to address the following allegations. LPA conducted resident and staff interviews and reviewed medication, training, and facility records. On 12/04/24, LPA conducted a subsequent complaint investigation and met with Executive Director Helen Lee and explained the purpose of the visit. During today’s investigation, LPA reviewed resident and facility records, reviewed medication, and interviewed staff. Regarding the allegation "Facility staff did not dispense medications as prescribed," it is being alleged staff gave Resident #1’s medication late or not at all. Specifically, medication #1, #2, and #3 was not given as instructed. Record review revealed medication #1 was administered daily except once in September 2024 and twice in October 2024 due to not being at the facility and hospitalization. Continue to LIC9099Read the full finding— CDSS inspection report, December 4, 2024 · control 11-AS-20241025161602

This is an amendment of the complaint investigation report dated 07/19/2024. The purpose of this amendment is to provide additional evidence obtained from records reviewed during the investigation. This amendment does not change the findings and the findings remain unsubstantiated. On 07/19/2024 Licensing Program Analyst (LPA) Mario Leon conducted a subsequent, unannounced, complaint visit to the above-mentioned facility at 9:00AM. LPA arrived at facility and was met by, Helen Lee, Executive Director (S1), and the purpose of the visit was explained. The investigation consisted of the following: On 10/03/24 LPA arrived at the facility at 09:30 to deliver this amended document. On 08/23/23 LPA obtained and reviewed facility documents, which included staff facility roster and facility resident roster and copies of resident’s medication admission record (MAR) (R1) and LPA interviewed four (4) residents and four (4) staff. On 07/19/24 LPA conducted a subsequent, unannounced, complaint visitRead the full finding— CDSS inspection report, July 19, 2024 · control 11-AS-20230815103818

**This report’s purpose is to provide an amendment to the complaint report created 01/10/2024. This addendum is written to clarify the 9099 and does not change the complaint investigation report findings recorded on 01/10/2024. ** On 01/10/2024 at 9:29 am Licensing Program Analyst (LPA) David España conducted an initiated a 10-day complaint investigation visit for the allegation listed above. Upon arriving at the facility, LPA met with S#1 who assisted with the visit. The purpose of today’s visit was discussed. Upon arrival at the facility, LPA conducted a risk assessment at the front door. Based on the assessment, the facility is not clear of Covid-19 infection (four (4) residents and one (1) staff member have COVID). LPA was granted access and allowed to enter the facility to conduct inspections.The investigation consisted of the following: On 01/10/2024 at 9:29 am LPA España conducted a tour of facility plant; reviewed records for staff and residents and observations. LPA España conRead the full finding— CDSS inspection report, January 10, 2024 · control 11-AS-20240103084316

On 11/15/2023 at 10:20 am Licensing Program Analyst (LPA) David España conducted an initiated a 10-day complaint investigation visit for the allegation listed above. Upon arriving at the facility, LPA met with S#1 who assisted with the visit. The purpose of today’s visit was discussed. Upon arrival at the facility, LPA conducted a risk assessment at the front door. Based on the assessment, the facility is clear of Covid-19 infection. LPA was granted access and allowed to enter the facility to conduct inspections. The investigation consisted of the following: On 11/15/2023 at 10:20 am LPA España conducted a tour of facility plant; reviewed records for staff and residents and observations. LPA España conducted interviews with Five (5) out of seventy-five (75) residents. LPA España interviewed Five (5) out of forty-seven (47) staff members. LPA España interviewed with one (1) out of one (1) Witness. Continued 9099-C UnsubstantiatedRead the full finding— CDSS inspection report, November 15, 2023 · control 11-AS-20231107132513

On 11/2/2023 at 10:56 AM, Licensing Program Analyst (LPA) Lourdes Montoya conducted a subsequent complaint visit to deliver complaint findings of the allegations listed above. LPA Montoya met with Helen Lee, the new Executive Director/Administrator, and explained the purpose of this visit. The investigations consisted of the following: On 9/12/2023, LPA conducted a tour of the facility. LPA Montoya interviewed 8 out of 76 residents and 7 out of 66 staff. LPA requested and obtained copies of Staff roster, Resident roster, and R1’s service records (Admission Agreement, Physician's Reports, Appraisals/Needs and Services Plans, and other pertinent records associated with this complaint. REPORT CONTINUED IN LIC 9099C UnsubstantiatedRead the full finding— CDSS inspection report, November 2, 2023 · control 11-AS-20230905082714

On 10/12/23, Licenising Program Analyst (LPA), Wendy Gibbs conducted an unnanounced visit to amend the report. LPA met with Executive Director Jayden Bennencourt and explained the purpose of today's visit. On 09/29/2023 at 10:00 a.m. Licensing Program Analyst (LPA) Jeremiah Randle conducted an unannounced visit to deliver the findings of the complaint allegation: Staff stole resident's money while in care. LPA identified himself and discussed the purpose of the visit and the elements of the allegation(s). with Assoc. Executive Director Jayden Bettencourt. The Investigation Consisted Of The Following On 06/28/23 Licensing Program Analyst (LPA) Jeremiah Randle conducted an unannounced 24-hour visit to Brookdale Ocean House. LPA was met by Matan Burstyn Executive Director. The Purpose of the visit was explained to investigate the allegation " Personal Rights” and conduct a health and safety check on residents in care. SubstantiatedRead the full finding— CDSS inspection report, September 29, 2023 · control 11-AS-20230627152651

Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced complaint visit on Monday, September 18, 2023. Upon arrival at the facility. LPA Bunker called the facility via telephone and conducted a Risk Assessment. Based on the assessment, the facility is cleared of COVID-19 infection. LPA Bunker met with Executive Director Matan Burstyn. LPA Bunker explained the purpose of today's visit. The investigation consisted of the following: On 11/07/2022, and 09/18/2023, LPA Bunker conducted interviews with both staff and residents concerning the allegation, which suggested that facility staff had failed to provide timely assistance to a resident who had fallen. Staff 1 through Staff 3 (S1-S3) and Residents 1 through 8 (R1-R8) were interviewed. S1 disclosed that R1 had reported her fall on 10/05/2022; however, the specific time of the fall was not mentioned by R1. S1 also noted that S2 had previously assessed the functionality of R1's pendant before the incident date, certifying itRead the full finding— CDSS inspection report, September 18, 2023 · control 11-AS-20221028153233

On 08/25/23, Licensing Program Analyst (LPA), Wendy Gibbs conducted an unannouced subsequent visit to the facility listed above to deliver findings for a complaint. LPA Gibbs met with Administrator, Matan Burstyn, and explained the purpose of today's visit. During today's visit LPA toured the facility and rendered findings. On the previous visit on 06/22/23, LPA Gibbs toured the physical plant with Administrator Burstyn. LPA Gibbs reviewed and received resident roster, staff roster, and staffing schedule. LPA Gibbs conducted interviews with Executive Director (S1), Staff (S2-S6), and Residents (R1-R8). The investigation revealed the following: CONTINUED ON LIC9099-C SubstantiatedRead the full finding— CDSS inspection report, August 25, 2023 · control 11-AS-20230614132722

Licensing Program Analyst (LPA)/Retired Annuitant (RA) Elizabeth Ceniceros made an unannounced visit to the facility and was greeted by the "new" Administrator (A2: Matan Burstyn, Executive Director) whom RA interviewed and explained the purpose of today's visit. LPA/RA conducted a risk assessment prior to entering facility. A2 informed LPA/RA that the facility has no COVID cases to report at this time nor do the residents or staff have symptoms. The purpose for this subsequent visit is to deliver the findings pertaining to the above-mentioned allegation. An initial 10-Day visit was conducted by LPA Martessa Brown on 12/01/22 with Staff #1 (S1: Amanda Monroy, Wellness Director) and was later met by Administrator (A1: Olga Kirskey, Executive Director). During this visit, LPA interviewed Administrator and Resident #1. LPA toured four (4) residents’ rooms on the 6th and 7th floors. LPA reviewed and obtained copies of the following documents: facility staff and resident rosters. SubstantiaRead the full finding— CDSS inspection report, July 27, 2023 · control 11-AS-20221123152901

On 06/22/23, Licensing Program Analyst (LPA), Wendy Gibbs, initiated a complaint visit at the facility listed above. LPA Gibbs met with Executive Director, Matan Burstyn, and explained the purpose of today's visit. During today's visit LPA Gibbs toured the physical plant with Executive Director Burstyn. LPA Gibbs reviewed and received resident roster, staff roster, and staffing schedule. LPA Gibbs conducted interviews with Executive Director (S1), Staff (S2-S6), and Residents (R1-R8). Today's investigation relealed the following: Allegation: Licensee does not ensure facility is adequately staffed to meet residents’ needs. During the visit LPA interviewed three (3 )caregivers, and two (2)Med-Tech/Caregivers. Two (2) of the caregivers and one (1) MedTech/Caregiver work the morning shift 6am-2 or 2:30pm. One (1) Caregiver covers floors 2- half of 6 and the other covers half of 6-10. On the evening shift there is one (1) Caregiver and one (1) Med-Tech/Caregiver from 2:00- 10:00pm. The nursRead the full finding— CDSS inspection report, June 22, 2023 · control 11-AS-20230614132722

On 03/29/2023, Licensing Program Analyst (LPA) Perry Scott conducted an initial complaint investigation to address the allegation listed above. LPA Scott met with Holly Rice, Associate Executive Director, and explained the purpose of this visit is to gather information for the complaint and deliver findings. On 03/29/2023, the investigation consisted of the following: LPA Scott conducted a tour of the facility grounds. The facility is a 10-story high-rise apartment building located in a residential beach neighborhood. The facility is licensed for a capacity of 150 non-ambulatory residents; with a hospice waiver for 5. The facility consisted of the following: 116 apartment units/with bathrooms with 2 elevator shafts. LPA interviewed the Assistant Executive Director, residents, reviewed records, and delivered findings. LPA Scott requested the following documents: 1) A copy of the staff roster, 2) a copy of the resident roster, 3) Any elevator repair invoices or repair proposals, and certRead the full finding— CDSS inspection report, March 29, 2023 · control 11-AS-20230321151417