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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306002962
Report Date: 05/21/2026
Date Signed: 05/21/2026 03:16:37 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, 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
01/07/2026 and conducted by Evaluator Andrea Mendivil
COMPLAINT CONTROL NUMBER: 22-AS-20260107153606
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: 115DATE:
05/21/2026
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:John Goodwin - Executive Director TIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Facility did not ensure resident was repositioned causing bruising
Facility is charging for services not provided
Facility did not ensure resident received food and water resulting in a change of condition
Facility did not address change of condition in resident
INVESTIGATION FINDINGS:
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On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to deliver complaint findings. LPA was greeted and granted entry into the facility and explained the reason for the visit.
The Department received the complaint on January 7, 2026 and LPA Mendivil conducted initial 10 day visit on January 15, 2026. During the visit LPA Mendivil obtained copies of records including resident admission record, physician report LIC 602, care plans for Resident 1 (R1) , and staff schedules. LPA Mendivil interviewed staff and residents. Regarding the allegations Facility did not ensure resident was repositioned causing bruising ,Facility is charging for services not provided, Facility did not ensure resident received food and water resulting in a change of condition, Facility did not address change of condition in resident the investigation revealed the following:
R1 lived at the facility since May 07, 2021 and moved out on December 30, 2025. Based on physician’s report LIC 602 dated January 21, 2025 indicated R1 was 100 years old and was diagnosed with Mild Cognitive Impairment. Per LIC 602 R1 was able to feed themselves and was non-ambulatory. R1 was placed on hospice on January 21, 2025.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2026
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-20260107153606
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: BROOKDALE BROOKHURST
FACILITY NUMBER: 306002962
VISIT DATE: 05/21/2026
NARRATIVE
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It was alleged that facility did not ensure resident was repositioned causing bruising. Per interviews with 5 out of 5 staff stated that R1 was repositioned. Per review of care notes bruising was noticed on R1’s heel which was notated by hospice. Interviews with staff stated they would not notate in care plans when a resident was repositioned. Staff stated they only chart issues out of the norm for the resident.
It was alleged that facility is charging for services not provided. Interviews with 5 out of 5 staff stated they were providing all services for R1. Interviews with 6 out of 6 residents stated all needs are being met and all services are being provided.
It was alleged that Facility did not ensure resident received food and water resulting in a change of condition. Per interviews with staff, staff stated that R1 was able to feed themselves until December 2025. 5 out of 5 staff deny that R1 was not provided with food and water. Per interviews with Executive Director John Goodwin stated that R1 was refusing food even with staff assistance around December 25, 2025 and hospice was notified. 6 out of 6 residents stated when they have received tray service they did not have issues receiving their food.
It was alleged the Facility did not address change of condition. Per interviews with 5 out of 5 staff stated that all change of conditions are brought up to med-techs or management. Per interviews with staff, it was stated that R1’s hospice was notified when R1 was refusing food and then R1 was moved a few days after their change in condition.
Therefore based on the preponderance of evidence through records reviewed and interviews the allegations Facility did not ensure resident was repositioned causing bruising ,Facility is charging for services not provided, Facility did not ensure resident received food and water resulting in a change of condition, Facility did not address change of condition in resident are determined to be UNSUBSTANTIATED, meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

No deficiencies are being cited in today's visit.
An exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2