397003261-9-18-2025-27-AS-LRIS-DM4Q5L-20251003115208

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 397003261
Report Date: 09/16/2025
Date Signed: 09/18/2025 02:34:47 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/26/2025 and conducted by Evaluator Arielle Pascua

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20250626082918

FACILITY NAME:	BROOKDALE TRACY		FACILITY NUMBER:	397003261
ADMINISTRATOR:	PRIYA LAL		FACILITY TYPE:	740
ADDRESS:	355 W GRANT LINE RD		TELEPHONE:	(209) 835-1000
CITY:	TRACY	STATE: CA	ZIP CODE:	95376
CAPACITY:	180	CENSUS: 112	DATE:	09/16/2025
		UNANNOUNCED	TIME BEGAN:	12:24 PM
MET WITH:	Priya Lal		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff did not provide a written notice to resident or resident's authorized representative prior to increasing the resident's facility fees
Staff did not provide assistance to resident in care in a timely manner
Staff did not provide contracted services to resident in care due to lack of staffing

INVESTIGATION FINDINGS:

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On 09/16/2025, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct a complaint visit. LPA met with Facility Designated Administrator (FDA), Priya Lal and explained the purpose of the visit. The purpose of this visit was to deliver complaint findings for the allegations above.

Current census was 112. A brief interview with FDA Lal was conducted,
Allegation: Staff did not provide written notice to resident or resident’s authorized representative prior to increasing the resident’s facility fees

It was alleged that staff did not provide written notice to resident or resident’s authorized representative prior to increasing the resident’s facility fees. During the course of this investigation, the department conducted interviews and reviewed records. Based on interviews, it was determined that Resident 1 (R1) had four Personal Service Plans updated on 11/03/2024, 12/19/2024, 04/08/2025, and 05/01/2025.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2025

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-20250626082918

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: BROOKDALE TRACY	FACILITY NUMBER: 397003261
	VISIT DATE: 09/16/2025

NARRATIVE

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Management initiated updates after identifying that R1 required additional services to meet their needs. Documentation confirms that R1 refused to sign the updated Personal Service Plans dated 04/08/2025 and 05/01/2025. Additionally, records indicate that R1 did not want any other parties involved in their care. Based on the information gathered, there is insufficient evidence to show that the staff did not provide a written notice to the resident or the resident’s authorized representative prior to increasing the resident’s facility fees.

Allegation: Staff did not provide assistance to resident in care in a timely manner.

It was alleged that staff did not provide assistance to resident in care in a timely manner. During the course of this investigation the department conducted interviews and reviewed records. Interviews revealed that facility staff frequently attempted to assist the resident with personal care; however, the resident often declined help, stating they did not need assistance and would contact staff if necessary. Staff also reported that the resident frequently refused care, but was capable of contacting emergency services when needed. A review of the facility’s daily notes confirmed that staff routinely checked on the resident as needed and throughout the day. Records also indicate that the resident consistently contacts emergency services and that the facility does not obstruct these services or intervene when the resident chooses to call them. Based on the information gathered, there is insufficient evidence to prove that staff did not provide assistance to resident in care in a timely manner.

Allegation: Staff did not provide contracted services to resident in care due to lack of staffing.

It was alleged that staff did not provide contract services to resident in care due to lack of staffing. During the course of this investigation, the department conducted interviews and reviewed facility records. Interviews revealed that facility staff regularly attempted to assist the resident with personal care; however, the resident frequently declined, stating they did not need help and would call staff if necessary. Staff also reported that the resident often refused care but was capable of contacting emergency services independently when needed. A review of the facility’s daily notes confirmed that staff checked on the resident as needed and throughout the day. Records further show that the resident consistently contacted emergency services, and that the facility neither obstructed access to these services nor intervened when the resident made such calls.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2025

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20250626082918

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: BROOKDALE TRACY	FACILITY NUMBER: 397003261
	VISIT DATE: 09/16/2025

NARRATIVE

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Additionally, interviews with other residents indicated general satisfaction with the facility and the services provided. A review of staffing records confirmed that the facility currently maintains sufficient staffing levels to meet residents’ needs.

Based on the information gathered, there is insufficient evidence to prove that staff did not provide contracted services to resident in care due to lack of staffing.

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 facility at the end of this visit.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2025

LIC9099 (FAS) - (06/04)

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