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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306002954
Report Date: 10/21/2025
Date Signed: 10/21/2025 03:28:33 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/16/2025 and conducted by Evaluator Celine Rodriguez
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20251016104903
FACILITY NAME:BROOKDALE IRVINEFACILITY NUMBER:
306002954
ADMINISTRATOR:CARRIE GALLOWAYFACILITY TYPE:
740
ADDRESS:10 MARQUETTETELEPHONE:
(949) 854-3766
CITY:IRVINESTATE: CAZIP CODE:
92612
CAPACITY:155CENSUS: 143DATE:
10/21/2025
UNANNOUNCEDTIME BEGAN:
11:52 AM
MET WITH:Executive Director - Shannon HowellTIME COMPLETED:
03:50 PM
ALLEGATION(S):
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Facility is not providing appropriate care for resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Celine Rodriguez conducted an unannounced 10-day visit to the facility for the complaint and to deliver the findings. LPA Rodriguez explained the purpose of today's visit and was greeted by Executive Director (ED) Shannon Howell.

During the investigation, LPA Rodriguez toured the physical plant of the facility, conducted interviews, and requested copies of pertinent records reviewed.

It was alleged that facility is not providing appropriate care for resident. 8 out of 8 resident interviews did not corroborate with the allegation by stating that facility provides “great care”. 1 out of 1 staff interview did not corroborate with the allegation. Per resident 1 (R1) admission agreement, R1 was not placed on a 1:1 supervision.

Continued on LIC9099-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Celine Rodriguez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025
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 2
Control Number 22-AS-20251016104903
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: BROOKDALE IRVINE
FACILITY NUMBER: 306002954
VISIT DATE: 10/21/2025
NARRATIVE
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Per R1 physician report, R1 has “poor safety awareness…high fall risk” “lack of impulse control”, and “lack of hazard awareness”. Per record review of incident reports, between the months of August-October, R1 sustained a fall on 9/29/25 and 10/14/25, of which 911 was contacted both times to ensure R1 obtained medical care. Per record review, it also revealed that a care plan meeting was held on 10/15/25 with R1’s responsible party to address R1’s falls and change of condition. LPA conducted a tour of R1’s room and observed that there were no hazards or obstructions in the room and also observed that R1 has accessibility to a pendant button to alert staff when needed.

Based on LPA’s interviews which were conducted, review of documents obtained, and observations, LPA is unable to ascertain if the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed UNSUBSTANTIATED.

An exit interview was conducted with ED Howell.

A copy of this report was provided and explained.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Celine Rodriguez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2