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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 415600874
Report Date: 07/03/2023
Date Signed: 07/03/2023 11:10:19 AM

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
03/10/2023 and conducted by Evaluator Jaime Vado
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20230310101703
FACILITY NAME:BROOKDALE REDWOOD CITYFACILITY NUMBER:
415600874
ADMINISTRATOR:MONICA CERON TAPIAFACILITY TYPE:
740
ADDRESS:485 WOODSIDE RDTELEPHONE:
(650) 366-3900
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94061
CAPACITY:130CENSUS: 70DATE:
07/03/2023
UNANNOUNCEDTIME BEGAN:
10:30 PM
MET WITH:Xuan TranTIME COMPLETED:
11:15 PM
ALLEGATION(S):
1
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9
- Resident sustained a fracture due to staff neglect
- Staff did not safeguard residents personal belongings
INVESTIGATION FINDINGS:
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2
3
4
5
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7
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9
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11
12
13
On this day Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced complaint investigation visit in order to deliver findings in regards to the investigation of the allegations listed above. LPA met with the dining services director Xuan Tran explained the purpose of today's visit. Administrator Monica Ceron Tapia is not in the facitliy until later today.

During the course of the investigaiton multiple interviews were conducted as well as documentation review. Per interviews conducted, it could not be determined if the resident sustained a fracture due to staff neglect due to conflicting information received from the resident. Regarding the personal belongings of the resident, it was found that the facility removed the cigarettes from the room of the resident as a safety precaution and the resident was smoking in the room which is against facility policy. The facility safeguarded the cigarettes for resident use when requested and staff assisted in taking him/her to the designated smoking area when requested. 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 Xuan Tran. No citations.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Cara SmithTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jaime VadoTELEPHONE: (559) 476-9353
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2023
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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