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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 397003261
Report Date: 12/28/2021
Date Signed: 12/29/2021 07:29:00 AM



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
11/04/2021 and conducted by Evaluator Arlene D Garcia
COMPLAINT CONTROL NUMBER: 27-AS-20211104123123
FACILITY NAME:BROOKDALE TRACYFACILITY NUMBER:
397003261
ADMINISTRATOR:PAMELA BRADLEYFACILITY TYPE:
740
ADDRESS:355 W GRANT LINE RDTELEPHONE:
(209) 835-1000
CITY:TRACYSTATE: CAZIP CODE:
95376
CAPACITY:180CENSUS: 119DATE:
12/28/2021
UNANNOUNCEDTIME BEGAN:
11:07 AM
MET WITH:Marites Rita, NurseTIME COMPLETED:
12:28 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility failed to allow resident council members to be interviewed during inspection process.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Arlene Garcia made an unannounced visit to Brookedale Tracy to deliver the finding of the above allegations. LPA was greeted by Marites Rita, Nurse and met with Executive Director (ED) Sara Mackedsky via telephone.
It was alleged the facility failed to allow resident council members to be interviewed during inspection process.
Records reviewed confirm on page 15 of Resident Admission Agreement states, ”Please note if you are a resident council member you have the right to be interviewed as part of the Department of Social Services regulatory inspection.” LPA Garcia and LPA Johnson confirm that during past inspections the council and any willing resident was allowed to be interviewed as part of the department’s inspection. LPA Garcia and LPA Johnson have invited council to meet with the LPAs on the day of a past inspection. The facility provided a private meeting space for the council and/or any willing resident to meet with the LPAs.

Therefore, the allegation the facility failed to allow resident council members to be interviewed during inspection process Is unsubstantiated.

Based on information provided through interviews and records reviewed, these allegations are deemed UNSUBSTANTIATED, meaning that there was not a preponderance of evidence to prove or disprove that the allegation occurred as reported.

Exit interview and copy of this report provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Arlene D GarciaTELEPHONE: 916-862-5907
LICENSING EVALUATOR SIGNATURE:

DATE: 12/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2021
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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