415600874-5-3-2023-14-AS-KHOS-CSBMEP-20230530093305

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 415600874
Report Date: 05/03/2023
Date Signed: 05/03/2023 12:53:25 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SF COASTAL AC/SC, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/04/2023 and conducted by Evaluator Jaime Vado

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20230404111015

FACILITY NAME:	BROOKDALE REDWOOD CITY		FACILITY NUMBER:	415600874
ADMINISTRATOR:	MONICA CERON TAPIA		FACILITY TYPE:	740
ADDRESS:	485 WOODSIDE RD		TELEPHONE:	(650) 366-3900
CITY:	REDWOOD CITY	STATE: CA	ZIP CODE:	94061
CAPACITY:	130	CENSUS: 72	DATE:	05/03/2023
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Monica Tapia		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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- Staff do not assist resident with toileting
- Staff do not respond to resident's calls for assistance
- Licensee does not adequately staff facility to meet resident needs

INVESTIGATION FINDINGS:

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On this day Licensing Progarm Analyst (LPA) Jaime Vado conducted an unannounced complaint investigation visit to deliver the findings for the above allegations. LPA met with the administrator Monica Tapia and explained the purpose of today's visit.

During the course of the investigation LPA conducted multiple interviews with residents and staff and reviewed pertinent documentation received such as resident care plans, reports, and staff scheduling. According to reveiwed items and interviews conducted with staff, the resident is assisted with "toileting" when called for. The facility defines toileting in the case for R1 as the changing of adult diapers as the resident is unable to self toilet. R1 is unable to bear weight or able to ambulate to the toilet with the assistance of staff any longer. When the assistance is summoned by R1 or R2 staff respond to that call via their call light/pendant system. Response times vary per interviews conducted with residents in care at the facility. A copy of the facility scheduling is reviewed and it is observed that staff are in place.

Continued on next page...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cara Smith	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jaime Vado	TELEPHONE: (559) 476-9353
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023

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 14-AS-20230404111015

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SF COASTAL AC/SC, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: BROOKDALE REDWOOD CITY	FACILITY NUMBER: 415600874
	VISIT DATE: 05/03/2023

NARRATIVE

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Response times again vary determinate on the needs of other residents as well as R1. Residents confirm on response times being adequate or satisfactory based on their needs. Review of the current staffing show night staff are available. Based on staff interviews R1 calls for assistance and based on history and the facility knowing his behaviors, they do not check unless R1 calls for assistance. Staff do respond but the times vary. These allegations are unsubstantiated.

Based on these observations, the above allegations are UNSUBSTANTIATED.
Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegations are unsubstantiated at this time.

Report is reviewed with the administrator.

SUPERVISOR'S NAME: Cara Smith	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jaime Vado	TELEPHONE: (559) 476-9353
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023

LIC9099 (FAS) - (06/04)

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