435202447-4-7-2021-26-AS-RMAO-BZYNBG-20210411101907

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202447
Report Date: 04/07/2021
Date Signed: 04/07/2021 01:00:21 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/25/2021 and conducted by Evaluator Gladys Kuizon

PUBLIC

COMPLAINT CONTROL NUMBER: 26-AS-20210125093924

FACILITY NAME:	BROOKDALE SAN JOSE		FACILITY NUMBER:	435202447
ADMINISTRATOR:	ODETTE COLONDRES TORRES		FACILITY TYPE:	740
ADDRESS:	1009 BLOSSOM RIVER WAY		TELEPHONE:	(408) 445-7770
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95123
CAPACITY:	153	CENSUS: 84	DATE:	04/07/2021
		UNANNOUNCED	TIME BEGAN:	11:36 AM
MET WITH:	Marie Harris		TIME COMPLETED:	12:02 PM

ALLEGATION(S):

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1. Staff member handles residents in a rough manner causing bruising.
2. Staff member does not remove trash from residents' rooms.
3. Staff member does not remove soiled linens from residents' bedding.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Gladys Kuizon conducted a complaint tele-visit today to deliver investigation findings. LPA met with Executive Director Marie Harris. Due to COVID-19 restrictions, facility visits have been suspended.

On January 25, 2021, the Department received the above allegations against the facility. An initial complaint investigation tele-visit was conducted on January 25, 2021.

Allegations stated that multiple residents have complained that staff (S1) is rough when assisting them. Additionally, S1 leaves soiled linens and trash in residents' room.

Continued, see LIC 9099-C, page 2 of 2.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Gladys Kuizon	TELEPHONE: (408) 834-2558
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2021

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 26-AS-20210125093924

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: BROOKDALE SAN JOSE	FACILITY NUMBER: 435202447
	VISIT DATE: 04/07/2021

NARRATIVE

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Facility inspections were conducted. On February 11, 2021 at 1:20 PM, a virtual tour of the Memory Care/Clarebridge unit was conducted. At 1:38 PM, the Assisted Living unit was toured. Residents' rooms # 150, #154, #156, #247, #248, and #256 were observed clean and trash bins were empty. On March 10, 2021 at 11:44 AM, facility was toured including common areas and kitchens. No unsanitary conditions including uncollected trash or soiled laundry were observed.

Residents were interviewed. 12 out of 12 residents who were interviewed stated housekeeping is good in the facility and staff collects trash and soiled linens regularly. All residents stated they have no complaints about cleanliness and housekeeping in the facility. 12 out of 12 residents stated no staff assists them in a rough or rude manner.

4 (R1-R4) out of 12 residents who were interviewed were alleged to have been complaining about S1 being rough with them. R1-R4 stated no staff have hurt them or been rough with them.

Staff were interviewed. 9 out of 10 staff who were interviewed stated they have not witnessed S1 being rough with residents. 1 staff (S2) stated residents (R1-R4) complained about S1 but S2 has not personally witnessed S2 being rough on these residents. S2 stated if S1 or any caregiver does not pick up trash or leaves soiled linens in residents' rooms, other caregivers will pick it up and collect it.

This Department has investigated these allegations. Based on interviews conducted and LPA's observation, the Department has found that these allegations are UNFOUNDED, meaning that the allegations are false, could not have happened and/or are without a reasonable basis.

This report was discussed with Executive Director and a copy provided electronically for signature.

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Gladys Kuizon	TELEPHONE: (408) 834-2558
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2021

LIC9099 (FAS) - (06/04)

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