397003261-9-9-2022-27-AS-KHOS-CJ8QM6-20220913121701

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 397003261
Report Date: 09/07/2022
Date Signed: 09/09/2022 11:20:03 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
07/08/2022 and conducted by Evaluator Arielle Pascua

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20220708152557

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:	DATE:	09/07/2022
		UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Chinny Takhar		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Insufficient staffing to meet residents' needs
Staff left resident unattended

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Arielle Pascua conducted an unannounced facility visit on 09/07/2022 to deliver complaint findings. LPA Pascua was greeted by receptionist, Reese Nimo and explained the purpose of the visit. LPA Pascua asked receptionist, Nimo to contact the facility representative to let them know that CCL was present at this time. Shortly after, LPA Pascua met with Clinical Care Director, Chinny Takhar.
The purpose of the visit was to deliver complaint findings from a complaint received by the department on 07/18/2022.
Throughout this investigation, LPA Pascua conducted interviewed and reviewed facility documents. LPA Pascua interviewed eight residents. Eight out of eight residents reported being satisfied with the care they are receiving and no issues with any staff. Eight out of eight residents also reported that they have do not have issues with staff leaving them unattended. Resident 1( R1) reported that there has been one issue with waiting too long for her call light to be answer but has not had any issues since.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Arielle Pascua	TELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2022

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-20220708152557

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: 09/07/2022

NARRATIVE

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LPA Pascua interviewed eight staff members. Eight out of eight staff members stated that they felt that there is short staff but feel that they all meet the needs of the residents. It was also learned during an interview with Chinny Takhar some positions were already hired for positions that were anticipated to be empty. LPA Pascua interviewed two family members. Two out of two family members stated that they were satisfied with the care that the staff was providing for their loved one and has not seen any family members left unattended.

As a result, it is unclear at this time that there was sufficient information to prove that the facility has insufficient staffing to meet the residents’ needs at this time and have left any resident unattended while providing care.

As a result of this investigation, the Department found the allegations to be UNSUBSTANTIATED. A complaint allegation finding of unsubstantiated meant that although the allegations may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred.

No deficiencies cited per Title 22 Regulations. Exit interview was conducted and a copy of this report was given to the Clinical Care Director, Chinny Takhar.

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Arielle Pascua	TELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2022

LIC9099 (FAS) - (06/04)

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