397003261-5-9-2022-27-AS-SDOB-CEGJWF-20220516072441

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 397003261
Report Date: 04/29/2022
Date Signed: 05/09/2022 07:48:32 AM

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
02/04/2022 and conducted by Evaluator Sarah Hurt

COMPLAINT CONTROL NUMBER: 27-AS-20220204155850

FACILITY NAME:	BROOKDALE TRACY		FACILITY NUMBER:	397003261
ADMINISTRATOR:	SARA MACKEDSY		FACILITY TYPE:	740
ADDRESS:	355 W GRANT LINE RD		TELEPHONE:	(209) 835-1000
CITY:	TRACY	STATE: CA	ZIP CODE:	95376
CAPACITY:	180	CENSUS: 118	DATE:	04/29/2022
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Business Services Coordinator Christina Goforth		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility does not keep food hot during meal service.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sarah Hurt arrived at the facility unannounced on April 29 ,2022 at 10:30 a.m. to investigate a complaint on the above allegations. LPA met with Business Services Coordinator Christina GoForth and explained the purpose for today’s visit.
Regarding the allegation facility does not keep food hot during meal service. Based on LPA interviews and observation the facility kitchen staff is keeping the food hot during meal service. LPA spoke with Resident 1 who did state during a COVID outbreak when facility staff was delivering food to all residents in their room due to dining being closed she was having some issues with the food being brought to her room cold. Resident 1 stated she is always served in her room daily and never goes to the dining hall. Resident 1 stated since things have been back to normal the food temperature is no longer an issue. Resident 1 stated the kitchen manager came to her room and listened to all of her concerns and has made all of her requested improvements. LPA spoke with Kitchen Staff 1 who stated she always listens to the residents when they have concerns related to the food and does what she can to take notes and make all improvements. Kitchen Staff 1 stated she recently ordered black plates to cover the food, and also brand new heat lamps to keep the food warm.
Continued on 9099C.....

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Sarah Hurt	TELEPHONE: (916) 879-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2022

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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Control Number 27-AS-20220204155850

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: 04/29/2022

NARRATIVE

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Continued from 9099...

Therefore, this complaint is UNSUBSTANTIATED. A finding that a complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

No deficiencies were cited per Title 22 Division 6. An exit interview was conducted with Business Services Coordinator Christina Goforth and a copy of this report was left at the facility.

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Sarah Hurt	TELEPHONE: (916) 879-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2022

LIC9099 (FAS) - (06/04)

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