435202447-5-2-2025-26-AS-KHOS-DGLS4A-20250512133226

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202447
Report Date: 05/02/2025
Date Signed: 05/02/2025 04:01:33 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 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
09/28/2021 and conducted by Evaluator Manuel Monter

COMPLAINT CONTROL NUMBER: 26-AS-20210928084109

FACILITY NAME:	BROOKDALE SAN JOSE		FACILITY NUMBER:	435202447
ADMINISTRATOR:	MARIE HARRIS		FACILITY TYPE:	740
ADDRESS:	1009 BLOSSOM RIVER WAY		TELEPHONE:	(408) 445-7770
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95123
CAPACITY:	153	CENSUS: 96	DATE:	05/02/2025
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Executive Director Zeinab Donner		TIME COMPLETED:	04:10 PM

ALLEGATION(S):

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Staff did not clean the resident's room

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Monter conducted an unannounced complaint inspection to deliver the findings on the above allegation. LPA met with Executive Director Zeinab Donner

On May 24, 2021, the Department received a complaint alleging Staff did not clean the resident's room.

On October 1, 2021, LPA Yatfai Eric Ng conducted an initial investigation.

LPA Ng interviewed residents R1-R4. R1 stated his/her room got cleaned and vacuumed every Wednesday. R1 requested spot cleaning on the carpet before and the staff came and addressed the issue. R1 said the caregivers and housekeepers kept his/her apartment clean. R2 and R3 stated the housekeeper came to their apartment once a week to clean and to vacuum. R2 and R3 stated they are satisfied with the cleaning service from the facility. R4 stated his/her room was cleaned and vacuumed weekly that he/she had no complaints. Page 1 Out of 2.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (408) 388-2297
LICENSING EVALUATOR NAME: Manuel Monter	TELEPHONE: (408) 324-2112
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2025

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-20210928084109

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: BROOKDALE SAN JOSE	FACILITY NUMBER: 435202447
	VISIT DATE: 05/02/2025

NARRATIVE

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LPA Ng interviewed Staff S1. S1 stated all residents' rooms are cleaned once a week. S1 stated It includes bedsheet changing, sink, floor cleaning, and carpet vacuuming. S1 stated Carpet spot cleaning would be conducted too. S1 there is a complimentary carpet cleaning service to every resident free of charge. S1 stated he/she did not receive any complaint that any resident's room was not being cleaned.

LPA Ng interviewed Executive Director Marie Harris, who stated, she did not receive any complaint from the residents or family about the rooms not being cleaned.

On May 2, 2025, LPA Monter interviewed residents R4-R17. 10 Out of 13 residents interviewed (R4-R14) stated their bedrooms are cleaned weekly and have no complaints or issues with their bedrooms being cleaned. 3 Out of 13 (R15-R17) residents interviewed declined to be interviewed.

LPA Monter interviewed staff S1-S10. 10 Out of 10 staff interviewed stated residents bedrooms are cleaned weekly by house keeping and care givers will spot clean any mess that is observed.

LPA Monter interviewed Executive Director Zeinab Donner stated resident bedrooms are cleaned once a week and if an accident occurs, it will be address at that moment. Executive Director Zeinab Donner stated she has not observed residents bedrooms not clean or neglected.

On May 2, 2025, LPA Manuel Monter toured the facility assisted living section of the facility and randomly toured the following bedrooms: 161, 244, 231, 229, 230, 243, 152, 163, 156. While touring these bedrooms, LPA Monter observed the bedrooms as clean, safe and sanitary.

LPA Monter toured all resident bedrooms in the memory care section of the facility: C1-C28. LPA Monter observed the bedrooms as clean, safe and sanitary.

The Department has completed the investigation of the above allegations. Based on interviews conducted and records review, the department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis.

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SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (408) 388-2297
LICENSING EVALUATOR NAME: Manuel Monter	TELEPHONE: (408) 324-2112
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2025

LIC9099 (FAS) - (06/04)

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