197802426-5-26-2020-28-AS-MVAO-BQ7Q45-20200602114944

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197802426
Report Date: 05/26/2020
Date Signed: 05/26/2020 04:00:09 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/18/2020 and conducted by Evaluator Kruz Long

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20200518131528

FACILITY NAME:	BROOKDALE ALHAMBRA		FACILITY NUMBER:	197802426
ADMINISTRATOR:	WENTWORTH, NICOLE D		FACILITY TYPE:	740
ADDRESS:	1 E COMMONWEALTH AVE		TELEPHONE:	(626) 289-3871
CITY:	ALHAMBRA	STATE: CA	ZIP CODE:	91801
CAPACITY:	150	CENSUS: 98	DATE:	05/26/2020
		UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Tracey Holder (Administrator)		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Resident is being charge for services not rendered.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kruz Long conducted a complaint investigation for the allegation listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and the implement mitigation measures, today's complaint investigation was conducted telephonically with Tracey Holder (Administrator).

During today's investigation, LPA called and interviewed Staff #1. Investigation revealed that admission for Resident #1 was never initiated and Resident #1 did not reside in the facility. Facility has no records of Resident #1.

This agency has investigated the complaint alleging Resident is being charge for services not rendered. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without reasonable basis. We have therefore dismissed the complaint.

A telephonic exit interview was conducted with Tracey Holder and a copy of this report was provided via email for signature.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Kruz Long	TELEPHONE: (323) 383-8117
LICENSING EVALUATOR SIGNATURE:	DATE: 05/26/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2020

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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