079201630-6-9-2026-15-AS-BFOG-DVTV75-20260709161033

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079201630
Report Date: 06/09/2026
Date Signed: 06/09/2026 05:24:55 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 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
06/03/2026 and conducted by Evaluator David Doidge

COMPLAINT CONTROL NUMBER: 15-AS-20260603113438

FACILITY NAME:	BRENTWOOD GROVE SENIOR LIVING		FACILITY NUMBER:	079201630
ADMINISTRATOR:	SHAHADE, SCOTT		FACILITY TYPE:	740
ADDRESS:	450 JOHN MUIR PARKWAY		TELEPHONE:	(925) 516-8006
CITY:	BRENTWOOD	STATE: CA	ZIP CODE:	94513
CAPACITY:	200	CENSUS: 132	DATE:	06/09/2026
		UNANNOUNCED	TIME BEGAN:	12:35 PM
MET WITH:	Executive Director Carol Dowell		TIME COMPLETED:	05:45 PM

ALLEGATION(S):

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Staff placed a surveillance camera in resident's room without proper authorization

INVESTIGATION FINDINGS:

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On 06/09/2026 at 12:15 PM, Licensing Program Analysts (LPAs) David Doidge and Andrew Christy arrived unannounced to conduct an initial 10-day complaint investigation and to deliver findings regarding the allegation above. LPAs met with Executive Director Carol Dowell and explained the purpose of the visit.

During the course of the investigation, LPAs obtained copies of the Identification and Emergency Contact Information, and Admission Agreements for three (3) residents. LPAs also obtained a copy of the notice to residents about the sage system. LPAs also interviewed W1, S1, S2, R1, R2, and toured the facility inspecting four rooms.

Allegation: Staff placed a surveillance camera in resident's room without proper authorization

Continued on LIC9099-C

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: David Doidge
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20260603113438

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: BRENTWOOD GROVE SENIOR LIVING	FACILITY NUMBER: 079201630
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/09/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/30/2026 Section Cited CCR 87468(a)(1)	1 2 3 4 5 6 7	(a) Residents in…facilities for the elderly…have personal rights…which include…those listed in Sections 87468.1(a)1)…and 87468.2(a)(1), Additional Personal Rights… as applicable to the facility…(1) “Privately Operated Facilities means an RCFE licensed to an individual, firm partnership, etc…; 87468.1(a)(1) states that (a) Residents … shall have…the following personal rights: (1) To be accorded dignity…; and 87468.2(a)(1) states that in addition to 87468.1 …(a) residents…shall have…the following personal rights (1) …have a reasonable level of personal privacy…	1 2 3 4 5 6 7	By POC due date, Executive Director to offer consent forms to all residenst for the devices and remove devices from rooms of residents that do not give consent,.
	8 9 10 11 12 13 14	This requirement was not met as evidence by: Based on interview, observation and record review, the facility installed cameras in R1, R2, R3 and R4 rooms without prior consent, which poses a potential health, safety, or personal rights risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: David Doidge
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2026

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20260603113438

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: BRENTWOOD GROVE SENIOR LIVING	FACILITY NUMBER: 079201630
	VISIT DATE: 06/09/2026

NARRATIVE

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Continued from LIC9099

Investigation Findings: It was reported to the department that staff have installed a camera in a resident’s bedroom without consent. LPAs inspected four resident rooms observing cameras in each room. R1 informed LPAs that they did not give consent to having the device installed in the room. R2 informed LPAs that they did not consent to having the camera installed in the room. S1 informed LPAs that the system has not been activated yet, so there is no feed. S1 stated he device is a fall detection system used for fall detection and do not record audio or video. Both S1 and S2 confirmed the facility has not given any resident a consent form. W1 informed LPAs that the cameras are not programmed for audio but could not confirm if the cameras are capable or not of audio. S2 informed LPAs that the facility has not yet gone live, so none of the cameras are functioning as the facility is awaiting approval of the sage system. LPAs reviewed the Admission Agreements for R1, R2 and R3, and noted that the Admission Agreement explicitly states there are to be no nanny cameras or other surveillance devices in resident rooms. LPAs also reviewed R1, R2, and R3’s files and noted no consent in their files for a camera to be installed. The preponderance of the evidence standard has been met, and therefore the allegation is SUBSTANTIATED.

Deficiency is cited from Title 22 California Code of Regulations (see LIC9099D). Failure to submit proof of correction by plan of correction due date and any repeat violation within 12 month period may result in an additional civil penalty.

Deficiency and plan and proof of correction were discussed with Executive Director Carol Dowell

Exit interview conducted, Appeal Rights, and a copy this report provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: David Doidge
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2026

LIC9099 (FAS) - (06/04)

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