397003261-10-21-2022-27-AS-KHOS-CKKMH3-20221026093652

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 397003261
Report Date: 10/20/2022
Date Signed: 10/21/2022 08:43:14 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
08/22/2022 and conducted by Evaluator Arielle Pascua

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20220822115520

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: 119	DATE:	10/20/2022
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Nori Dugan		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility is unsanitary.
Facility is odiferous.
Facility is dirty.
Staff are not cleaning resident's bedding.
Staff are not changing resident's clothing
Requests for communication by resident's representative are not being responded to by staff in a timely manner.

INVESTIGATION FINDINGS:

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On 10/20/2022 at 1:15pm, Licensing Program Analyst (LPA) Arielle Pascua arrived at the facility unannounced to conduct a complaint visit. LPA Pascua was greeted by receptionist, Amanda Battles and explained the purpose of the visit. LPA Pascua asked receptionist Battles to contact the Facility Designated Administrator, Robert Alvarado to let them know that CCL was present at this time. Receptionist Battles could not reach FDA Alvarado at home Shortly after, LPA Pascua met with . The purpose of the visit was to deliver complaint findings from a complaint received by the department on 08/22/2022.
Allegation(s): Facility is dirty and Facility is unsanitary.
LPA Pascua interviewed 8 residents, 6 staff members and 4 family members. 8 out of 8 residents reported that their rooms were cleaned and sanitary on a weekly basis and that the staff does a good job in ensure that their rooms are maintained. 6 out of 6 staff members stated that they do not believe that the facility is dirty and have a routine that is based on the residents needs.

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: 10/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022

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-20220822115520

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: 10/20/2022

NARRATIVE

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6 out of 6 staff members also state that common areas are routinely sanitized. 3 out of 4 family members stated that they believe that the facility is well kept and clean and do not see any issues with the cleanliness of their family members rooms. 1 out 4 family members stated that they believe that their family members room is dirty and needs additional attention. LPA Pascua also obtained a copy of the facilities housekeeping schedule. LPA Pascua observed that each resident room is cleaned at least once a week. The facilities common areas, floors, baseboards, and windows are cleaned daily. As a result, it is unclear at this time that there is sufficient information to prove that the facility is dirty and unsanitary.

Allegation: Facility is odiferous.
LPA Pascua interviewed 8 resident, 6 staff members and 4 family members. 8 out 8 residents reported that they do not believe that any part of the facility smells. 6 staff members also stated that they do not smell anything out of the ordinary at the facility. 4 out 6 staff members stated that some smells are more common than others in different resident rooms and areas of the facility due to residents who may be incontinent and need more attention. Additionally, during LPAs visit to this facility during the course of this investigation. LPA Pascua did not observe any strong and usual smells. As a result, it is unclear at this time that there is a sufficient information to prove that the facility is odiferous.

Allegation: Staff are not cleaning resident’s bedding

LPA Pascua interviewed 8 residents, 6 staff members, and 4 family members. 8 out of 8 residents stated that they get their laundry done weekly and will notify the staff if they need additional laundry services. 6 out of the 6 staff members stated that laundry services are provide to each resident at least once a week. Laundry staff stated that they have a schedule on whose laundry to do during the week. Laundry staff also reported that on some days care staff will notify them of laundry needs to be done as soon as possible for residents whose bedding may be soiled. 3 out 4 family members stated that some time to time they have some issues with laundry but have clarified some issues with management and have been fixed since. Additionally, LPA Pascua reviewed the laundry schedule. Laundry services for each resident is done at least once a week. Once bedding or clothing is soiled, the resident’s laundry will be done automatically that day. Based on interviews conducted and facility records with facility staff, family and residents it is unclear if staff is not cleaning resident bedding.

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Arielle Pascua	TELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20220822115520

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: 10/20/2022

NARRATIVE

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Allegation: Staff are not changing resident's clothing
LPA Pascua interviewed 6 staff members and 4 family members. 6 out 6 staff members state that they change resident clothing once they see that a residents clothing is soiled. 6 out of 6 staff members state that they change residents clothing once a day. They also report that resident may be changed throughout the day depending on their needs. 4 family members stated that their family members are usually in clean clothing and if they have any issues with their family members clothing being changed, they notify care staff. Based on interviews conducted and facility records with facility staff, family and residents it is unclear if staff is not cleaning resident bedding.

Allegation: Requests for communication by resident's representative are not being responded to by staff in a timely manner.
LPA Pascua interviewed 4 family members and 4 staff members. 3 out of 4 family members stated that they do not have any issues at this time communicating with the facility. 1 out of 4 family members stated they do have issues and have not been able to reach a facility representative but have been able to in the past. 4 out of 4 staff members stated that they emphasize reporting back to the resident’s family members as soon as there are any changes in their condition or have any concerns about their family members’ care. Staff members also reported that family members will often call about different issues and are directed to the correct party. 1 out of 4 staff members stated that emails are also sent out as reminders to reach out to family members about any concerns they may have. Based on facility staff and family interviews it is unclear if staff are responding to resident's representative at this time.

As a result of this investigation, this 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.

There were no deficiencies observed or cited at this time. An exit interview was conducted, a copy of the 9099 and 9099-C was provided to the Heath Wellness Director, Nori Dugan.

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Arielle Pascua	TELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022

LIC9099 (FAS) - (06/04)

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