015601255-6-19-2025-15-AS-HHUL-DHYLJT-20250625084825

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 015601255
Report Date: 06/19/2025
Date Signed: 06/19/2025 03:29:00 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/14/2022 and conducted by Evaluator Alicia Delmundo

COMPLAINT CONTROL NUMBER: 15-AS-20220114083424

FACILITY NAME:	BROOKDALE NORTH FREMONT		FACILITY NUMBER:	015601255
ADMINISTRATOR:	EBONY (LADY) REED		FACILITY TYPE:	740
ADDRESS:	38035 MARTHA AVE		TELEPHONE:	(510) 797-4011
CITY:	FREMONT	STATE: CA	ZIP CODE:	94536
CAPACITY:	40	CENSUS: 25	DATE:	06/19/2025
		ANNOUNCED	TIME BEGAN:	02:40 PM
MET WITH:	Maria George/Dining Services Manager		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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-Residents are not being showered timely.

-Residents are not being changed timely.

-Residents needs are not being met due to a lack of staffing.

-Staff are not following COVID-19 protocols.

INVESTIGATION FINDINGS:

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On this day, June 19, 2025, at 2:40 pm, Licensing Program Analyst (LPA) Delmundo arrived unannounced to deliver the findings for the above allegations. LPA was granted entry by Marketing Director Ryan Maltoni. LPA spoke over the phone with Divisional Director of Operations (DDO) Laura Eckert, and informed the reason for vist. LPA met after several minutes with Dining Service Manager Maria George whom DDO authorized to sign and receive this report.

During the course of investigation, LPA obtained copies of LIC9020 Register of Facility Clients/Residents, LIC500 Personnel Report, staff schedules and staff's Food Service Training. LPA interviewed the following: staff (S1) on 1/19/22; residents (R1, R2) and staff (S2, S3, S4, S5, S6) and previous Executive Director (PED) on 5/29/25

.....continued on 9099C (page 2)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2025

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 4

Control Number 15-AS-20220114083424

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: BROOKDALE NORTH FREMONT	FACILITY NUMBER: 015601255
	VISIT DATE: 06/19/2025

NARRATIVE

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Page 2

Allegation: Residents are not being showered timely.
All 5 staff interviewed stated the residents are showered 2 or 3x per week depending on the resident’s Care Plan. If resident refused, they endorse and report to their supervisor and med-tech and the next shift care staff will try to provide shower. During investigation, LPA observed the residents were clean. Due to medical diagnosis, LPA was not able to obtain information from the 2 residents. Therefore, the allegation is closed as unsubstantiated.

Allegation: Residents are not being changed timely.
All the 5 staff interviewed stated residents are changed 2 to 3x times during their shift and as needed. PED stated there are some residents who still can go to the bathroom but residents are checked every 2 hours and diapers are changed as needed. LPA didn’t observe resident with urine odor. Due to medical diagnosis, LPA was not able to obtain information from the 2 residents. Therefore, the allegation is closed as unsubstantiated.

Allegation: Residents needs are not being met due to a lack of staffing
Reporting party (RP) stated that the laundry was not being done. RP also stated the activity director is cooking, because the cook quit and sometimes care staff were pulled to cook.

All the 5 staff interviewed stated they were never pulled from the floor to cook. When the cook quit, S1 came on board to do the cooking. LPA interviewed S1 who confirmed he was the pro tem cook at that time.

........continued on 9099C (page 3)

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 15-AS-20220114083424

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: BROOKDALE NORTH FREMONT	FACILITY NUMBER: 015601255
	VISIT DATE: 06/19/2025

NARRATIVE

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Page 3

The 5 staff including the PED stated the residents never run out of clean clothing. The PED also stated the facility has 2 washers and it never happened that both are broken at the same time. When one is broken, it gets fixed right away. Two of the 5 staff stated they remember there was a year when the laundry machines were broken but the residents never run out of clean clothing because the laundry were dropped off and picked-up from the laundry service location by care staff assigned and were already washed and folded when picked-up.

The 5 staff stated that during the previous years when facility had COVID-19 outbreaks and staff called off, the facility contracted with staffing agency. The PED stated that when she came on board in 2024, they didn't have problem with staffing and didn't utilize staffing agency. Due to medical diagnosis, LPA was not able to obtain information from the 2 residents. Therefore, the allegation is closed as unsubstantiated.

Allegation: Staff are not following COVID protocols.
RP stated there’s no designated area for the COVID-19 positive residents and staff work on both positive and negative residents.

All 5 staff interviewed stated there was no cross-over of care staff from positive residents to negative residents or vice versa. The facility followed the protocol and guidance from Public Health, Community Care Licensing and Brookdale corporate. All these staff including the PED stated residents who tested positive of COVID-19 were isolated. They stated some residents who were on isolation due to medical diagnosis came out of isolation but when this happened, they redirected the residents back to their rooms or separate them from the negative residents in the common area. Due to medical diagnosis, LPA was not able to obtain information from the 2 residents. Therefore, the allegation is closed as unsubstantiated.

......continued on 9099C (page 4)

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 15-AS-20220114083424

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: BROOKDALE NORTH FREMONT	FACILITY NUMBER: 015601255
	VISIT DATE: 06/19/2025

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32	Page 4 Based on interviews, observation and records reviews, the four allegations were closed as unsubstantiated as there is not a preponderance of the evidence to prove that the alleged violations occurred. No deficiency cited. Exit interview conducted and copy of this report provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2025

LIC9099 (FAS) - (06/04)

Page: 4 of 4