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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306002962
Report Date: 07/29/2025
Date Signed: 07/29/2025 09:35:32 AM

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
07/15/2025 and conducted by Evaluator Michael Tea
COMPLAINT CONTROL NUMBER: 22-AS-20250715155510
FACILITY NAME:BROOKDALE BROOKHURSTFACILITY NUMBER:
306002962
ADMINISTRATOR:JOHN GOODWINFACILITY TYPE:
740
ADDRESS:15302 BROOKHURST STTELEPHONE:
(714) 775-6775
CITY:WESTMINSTERSTATE: CAZIP CODE:
92683
CAPACITY:164CENSUS: 113DATE:
07/29/2025
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:John GoodwinTIME COMPLETED:
09:50 AM
ALLEGATION(S):
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- Staff are not ensuring resident is accorded privacy
- Staff inappropriately removed resident's door
INVESTIGATION FINDINGS:
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On this day, Licensing Program Analyst (LPA) Michael Tea made an unannounced visit to conclude and deliver findings for a complaint investigation. LPA Tea was greeted and granted entry by facility staff and explained the reason for the visit. Executive Director (ED) John Goodwin arrived shortly to assist with the visit.

The Department received a complaint on July 15, 2025, and LPA Tea conducted the initial 10-day visit the following week on July 24, 2025. LPA Tea spoke to residents and facility staff and reviewed and collected pertinent documents and information.

It was alleged that staff are not ensuring resident is accorded privacy. LPA interviewed residents who live in shared suites and asked them about their privacy. Eight out of nine residents interviewed agreed that the facility tried their best to afford their privacy despite having to have a roommate. If something bothered them, the facility was willing to accommodate and seek solutions. There are no complaints about privacy
Complaint Report continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2025
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 5
Control Number 22-AS-20250715155510
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 BROOKHURST
FACILITY NUMBER: 306002962
VISIT DATE: 07/29/2025
NARRATIVE
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among the seven residents interviewed. LPA spoke to two residents who shared a room together. One resident, Resident 1 (R1) interviewed, felt the facility did not do anything enough and felt their privacy was violated. The resident complained that their roommate played the television 24 hours non-stop. The facility had made both residents come to an agreement but R1 did not feel the roommate did not follow the agreement and remained unresolved. Two staff interviewed felt the facility did their best to accommodate their privacy with residents who shared an apartment together. They offered solutions with residents but with R1, they did not like the options and had made up their mind of leaving the facility.

It was alleged that staff inappropriately removed resident’s door. Staff explained to LPA that residents who share an apartment together share the entire space together. There are no designated spaces for any of the residents in the shared apartment. Residents are fully aware when they move in that the entire space of the room is shared. Some shared resident rooms have a door because if not shared, the apartment is a one-bedroom apartment. When it is shared the apartment is called a semi-private or companion suite and residents can decide if they want to keep the door or remove it. If the door remains in the shared apartment, the staff remind the residents to be mindful of sharing the entire space together and that the facility can remove the door if needed when issues occur between residents. With two of the nine residents interviewed, residents had an issue with each other where one resident closed the door not allowing the air conditioning to come through the entire apartment. The other resident had problems with the television noise. As a result of them having issues, the staff removed the door. Two of the staff interviewed did say that both residents agreed to have the door being removed. R1 said they did not agree to it. One staff member said after the agreement was made between R1 and their roommate, R1 said the noise was better and gave permission to remove the door. Since the entire space of the apartment is shared all residents have access to any part. Residents signed the admission agreement in where the section, “Alterations” acknowledges that the facility may make alterations to meet the requirements of any applicable law or regulation. In this case both residents are not afforded equal access to the shared space, so the facility made the decision to take the door down.

Therefore, based on LPA Tea's observations and interviews conducted and records reviewed the allegations staff are not ensuring resident is accorded privacy and staff inappropriately removed resident’s door has been determined to be unsubstantiated meaning that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

Complaint Report continued on LIC9099-C
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 22-AS-20250715155510
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 BROOKHURST
FACILITY NUMBER: 306002962
VISIT DATE: 07/29/2025
NARRATIVE
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No deficiencies cited at this time and an exit interview was conducted with Executive Director John Goodwin. A copy of the report and confidential names list were provided to the facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
07/15/2025 and conducted by Evaluator Michael Tea
COMPLAINT CONTROL NUMBER: 22-AS-20250715155510

FACILITY NAME:BROOKDALE BROOKHURSTFACILITY NUMBER:
306002962
ADMINISTRATOR:JOHN GOODWINFACILITY TYPE:
740
ADDRESS:15302 BROOKHURST STTELEPHONE:
(714) 775-6775
CITY:WESTMINSTERSTATE: CAZIP CODE:
92683
CAPACITY:164CENSUS: 113DATE:
07/29/2025
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:John GoodwinTIME COMPLETED:
09:50 AM
ALLEGATION(S):
1
2
3
4
5
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8
9
- Staff did not ensure resident's room was not used as a passageway to the bathroom
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
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10
11
12
13
On this day, Licensing Program Analyst (LPA) Michael Tea made an unannounced visit to conclude and deliver findings for a complaint investigation. LPA Tea was greeted and granted entry by facility staff and explained the reason for the visit. Executive Director (ED) John Goodwin arrived shortly to assist with the visit.

The Department received a complaint on July 15, 2025 and LPA Tea conducted the initial 10-day visit the following week on July 24, 2025. LPA Tea spoke to facility staff and residents and reviewed and collected pertinent documents and information.

It was alleged staff did not ensure resident’s room was not used as a passageway to the bathroom. The investigation determined the following: Residents are in a semi-private suite where all the space is shared and both have access. There is no designation of space for the residents in the shared semi-private suite.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 22-AS-20250715155510
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 BROOKHURST
FACILITY NUMBER: 306002962
VISIT DATE: 07/29/2025
NARRATIVE
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The residents share the bathroom, closet, kitchenette and the rest of the suite, it is accounted for as one shared space. Two facility staff interviewed said residents who sign up for these rooms are aware before moving into these shared suites that everything is shared and there is no room or part of the room given to a resident. One staff member explained that residents were explained and shown the configurations of the suites prior to moving in during a room tour. The residents accepted and were aware that everything in the suite space must be shared and all residents have equal access to the space. 8 out 9 residents confirmed they were aware about moving into a shared space and the nature of the space prior to moving in.

Therefore, based on LPA Tea's observations, interviews conducted, and records reviewed the allegation that staff did not ensure resident’s room was not used as a passageway to the bathroom has been determined as UNFOUNDED, meaning the allegation is false, could not have happened and/or is without a reasonable basis.

No deficiencies cited at this time and an exit interview was conducted with Executive Director (ED) John Goodwin. A copy of the report was provided to the facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5