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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 397003261
Report Date: 08/23/2021
Date Signed: 08/23/2021 04:27:21 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/20/2021 and conducted by Evaluator Arlene D Garcia
COMPLAINT CONTROL NUMBER: 27-AS-20210720104703
FACILITY NAME:BROOKDALE TRACYFACILITY NUMBER:
397003261
ADMINISTRATOR:ODETTE COLONDRESFACILITY TYPE:
740
ADDRESS:355 W GRANT LINE RDTELEPHONE:
(209) 835-1000
CITY:TRACYSTATE: CAZIP CODE:
95376
CAPACITY:180CENSUS: 117DATE:
08/23/2021
UNANNOUNCEDTIME BEGAN:
12:32 PM
MET WITH:Sara Mackedsy, Executive DirectorTIME COMPLETED:
02:25 PM
ALLEGATION(S):
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Licensee failed to have sufficient staff to meet the needs of the residents.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Arlene Garcia made an unannounced visit to Brookdale Tracy to deliver the finding of the above allegations. LPA met Sara Mackedsy, Executive Director.

The initial 10 day Visit was conducted on 7/28/2021.

Through the course of the investigation, LPA conducted interviews, reviewed staff/ resident records and facility records. It was alleged that the licensee failed to have sufficient staff to meet the needs of the residents.

9099 CONT. >>>>>>>>>>>>>>>>>>>>>>>>>
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Arlene D Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2021
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 27-AS-20210720104703
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: BROOKDALE TRACY
FACILITY NUMBER: 397003261
VISIT DATE: 08/23/2021
NARRATIVE
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9099 CONT.>>>>>>>>>>>>>>>

LPA toured facility and observed residents lunch mealtime. ED stated lunch starts at 1130am. At approximately 12pm, LPA observed 18 residents in Assisted Living already served lunch and enjoying their dessert. LPA observed/met with 3 residents (R5),(R2),and (R3). R5 stated R5 had no concerns about meal service. R2 had just finished meal but requested to bring additional food to room. LPA observed S1 packing up food for R2 upon request. R3 stated just sat down and order was taken within 5 minutes of R3 entering dining hall. LPA observed 6 additional residents enter the dining hall. LPA observed within approximately 3 minutes of seating, S2 and S3 were at their tables taking their orders.

It was alleged that the licensee failed to have sufficient staff to meet the needs of the residents. RP specifically noted residents having to wait for over an hour for their meal service. LPA toured the facility and found sufficient staff to meet the residents needs. Residents interviewed were either speaking on behalf of other residents and did not experience the shortage in staff during meal time. Additional residents interviewed stated they had no concerns about the wait during mealtime and the response support they received to meet their needs. Based on information provided through interviews and documentation, it was unclear if licensee failed to have sufficient staff to meet the needs of the residents.
Therefore, the allegation that the licensee failed to have sufficient staff to meet the needs of the residents. is deemed UNSUBSTANTIATED. There was not a preponderance of evidence to prove or disprove that the allegation occurred as reported therefore the allegation was found to be Unsubstantiated.

An exit interview was conducted with Sara Mackedsy, ED and a copy of this report 9099 and Appeal Rights was provided via email.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Arlene D Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2021
LIC9099 (FAS) - (06/04)
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