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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 397005466
Report Date: 07/24/2026
Date Signed: 07/24/2026 01:19:31 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
05/11/2026 and conducted by Evaluator Kesha Lewis
COMPLAINT CONTROL NUMBER: 27-AS-20260511154015
FACILITY NAME:BROOKDALE KETTLEMAN LANEFACILITY NUMBER:
397005466
ADMINISTRATOR:MARY MARGARET CHAPPELLFACILITY TYPE:
740
ADDRESS:2150 W KETTLEMAN LNTELEPHONE:
(209) 333-8033
CITY:LODISTATE: CAZIP CODE:
95242
CAPACITY:56CENSUS: 45DATE:
07/24/2026
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Jessica Zamora TIME COMPLETED:
11:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not reporting incidents to authorized representatives
Due to lack of staff, residents are left unattended
Staff are not assisting residents due to lack of staff
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 07/24/2026, Licensing Program Analyst (LPA) Kesha Lewis conducted an unannounced facility visit to deliver findings for complaint for the above allegations. LPA met with Health and wellness Director and explained the purpose of today's visit.

Based on the records reviewed that show there is 4 care givers and two medication tech and LVN on call at night and during the day there is no less then 5 care givers one LVN and two med techs, and interviews with authorized representatives that confirm they were notified of an insident with their family member. The allegations above are UNSUBSTANTIATED. A finding of unsubstaniated means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, and therefore the allegation is unsubstantiated.

An exit interview was conducted, and a copy of this report was provided to the facility.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2026
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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