415600874-8-29-2023-14-AS-KHOS-CVKGQC-20230911053231

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 415600874
Report Date: 08/29/2023
Date Signed: 08/29/2023 03:42:48 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
08/08/2022 and conducted by Evaluator Jaime Vado

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20220808133341

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:	08/29/2023
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Monica Tapia		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Multiple times resident was left in soiled clothing for extended periods of time
Facility has insufficient staffing to meet the residents’ needs
Staff did not assist resident in a timely manner

INVESTIGATION FINDINGS:

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On this day Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced complaint inspection visit in order to deliver the findings regarding the allegations received. LPA met with administrator Monica Tapia and explained the purpose of today's visit.

During the investigation LPA conducted interviews, made observtions, and reviewed pertinent documents. Staffing is observed as in place. Interviews conducted at random with residents did not result in statements leading to staff not assisting timely. R1 does require double assist but with specific items only that is outlined as a double assist according to the care plan. The double assist is not needed at all times. Staff interviewed also did not have much knowledge of the situation as they were not present at the time the allegations were made. LPA discussed and advised on the use of staffing agencies if needed. Due to the length of time, changes in staffing, and leadership roles the facility environment is different compared to then and now. LPA could not prove or disprove the allegations received.

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 Monica.

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: 08/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023

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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