415600874-12-29-2022-14-AS-CSMH-CMLS5S-20221230123448

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 415600874
Report Date: 12/29/2022
Date Signed: 12/29/2022 12:24:06 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
11/09/2022 and conducted by Evaluator Jaime Vado

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20221109110234

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: 77	DATE:	12/29/2022
		UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Baneen Amiri		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Staff is serving expired food to residents.

INVESTIGATION FINDINGS:

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On this day Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced complaint investigation visit to close and deliver findings in regards to the allegation received. LPA met with Wellness Director Baneen Amiri and explained purpose of today's visit.

During the course of the investigation LPA interviewed staff and made observations in regards to food storage and supplies. In an interview with the diining director Xuan Tran, it was stated that the milk was not expired. A review of the milk served was made in the food supply and she confirmed it was not expired. It was explained that the milk was left out for the resident for lunch, and the resident did not pick it up. The milk was warm but not expired. The food was not sitting out for a long time but long enough to have the milk get warm. The facility implimented a plan so that the resident's food and milk is not sitting out and the is stored if food if not picked up right away. This allegation is unsubstantiated.

Report is reveiwed with the welness director Baneen Amiri.

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: 12/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2022

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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