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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 415600874
Report Date: 08/12/2022
Date Signed: 08/12/2022 12:08:14 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
09/17/2020 and conducted by Evaluator Jaime Vado
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20200917154101
FACILITY NAME:BROOKDALE REDWOOD CITYFACILITY NUMBER:
415600874
ADMINISTRATOR:NDOMO, GRACEFACILITY TYPE:
740
ADDRESS:485 WOODSIDE RDTELEPHONE:
(650) 366-3900
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94061
CAPACITY:130CENSUS: 79DATE:
08/12/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Monica Ceron TapiaTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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9
Staff failed to provide appropriate sleeping arrangement for resident
Staff failed to seek timely medical attention for resident
Staff failed to safeguard resident's personal belongings
Staff failed to provide hygiene products for residents while in care
Staff failed to respond to resident's alerts
Staff failed to notify authorized representative regarding resident
INVESTIGATION FINDINGS:
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13
On this day Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced complaint investigation visit. LPA met with administrator Monica Ceron Tapia.

It was found that the resident these allegations pertain to does not reside at this facility. The resident resides at a sister facility in Scotts Valley, California. 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.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jackie JinTELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Jaime VadoTELEPHONE: (559) 476-9353
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2022
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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