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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 397003771
Report Date: 08/17/2022
Date Signed: 08/17/2022 03:13:33 PM

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
06/30/2022 and conducted by Evaluator Renee Campbell
COMPLAINT CONTROL NUMBER: 27-AS-20220630115330
FACILITY NAME:BROOKDALE LODIFACILITY NUMBER:
397003771
ADMINISTRATOR:MARY MARGARET CHAPPELLFACILITY TYPE:
740
ADDRESS:2220 W. KETTLEMAN LANETELEPHONE:
(209) 367-8870
CITY:LODISTATE: CAZIP CODE:
95242
CAPACITY:82CENSUS: DATE:
08/17/2022
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Mary Margaret Chappell, Executive DirectorTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff billed resident in excess of the agreed upon rates provided in the Admission Agreement.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 08/17/2022 at 9:45am, LPA R. Campbell and Michael Bilger arrived unannounced to facility to continue the complaint investigation for the allegation noted above. During this investigation, LPA Campbell interviewed Administrator and complainant, and reviewed admission agreement and billing statements for resident1 (R1). Based on interviews and record reviews, it was determined that there was no intention to overbill. It was found that there was a misunderstanding of the facility's billing process and funds were returned. There is no evidence of an actual physical bill received. Funds have been returned as requested.

As a result, this allegation is UNSUBSTANTIATED. An exit interview was conducted with Mary Margaret Chappell and copy of this report was provided to Mary.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Renee CampbellTELEPHONE: 916-206-6380
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2022
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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