445294156-4-20-2026-26-AS-CKAI-DU2U2U-20260513151228

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 445294156
Report Date: 04/20/2026
Date Signed: 04/20/2026 04:12:55 PM

Unsubstantiated

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
08/13/2025 and conducted by Evaluator Marcella Tarin

COMPLAINT CONTROL NUMBER: 26-AS-20250813113122

FACILITY NAME:	BROOKDALE SCOTTS VALLEY		FACILITY NUMBER:	445294156
ADMINISTRATOR:	KUMAR, BEENA		FACILITY TYPE:	740
ADDRESS:	100 LOCKEWOOD LN		TELEPHONE:	(831) 438-7533
CITY:	SCOTTS VALLEY	STATE: CA	ZIP CODE:	95066
CAPACITY:	220	CENSUS: 162	DATE:	04/20/2026
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Executive Director (ED) Alex Baiasu		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Staff are not meeting residents nutritional needs.
Staff are not meeting residents bathing needs.
Staff are leaving residents soiled for an extended period of time.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced complaint investigation visit. LPA met with Executive Director (ED) Alex Baiasu. LPA stated the purpose of the visit.

On 8/14/2025 the Department conducted a complaint investigation visit.

On 8/26/2025 the Department interviewed the Reporting Party (RP). RP states he/she observed a resident, referred to as R1, for approximately 4 hours on 8/10/2025 and R1 stated facility staff were not feeding him/her and not taking him/her to eat in the dining area. RP did not provide additional information.

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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2026

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-20250813113122

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 SCOTTS VALLEY	FACILITY NUMBER: 445294156
	VISIT DATE: 04/20/2026

NARRATIVE

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On 8/14/2025 the Department conducted a complaint investigation visit and obtained documentation.

On 9/18/2025, 4/6/2026 and 4/20/2026 the Department interviewed 4 Staff, (S1 to S4), 3 Residents (R2 to R4), and 1 Witness. 4 Out of 4 staff stated he/she is not aware of residents not receiving meals or not being taken to the dining hall for meals. S3 stated R1 had a personal preference to eat in his/her room.

On 4/20/2026 the Department interviewed 3 Residents (R2 to R4). 3 Out of 3 residents stated he/she does not need assistant with receiving his/her meal and does not need to be taken to the dining hall. 3 Out of 3 residents state he/she has no issues or concerns with receiving his/her meals.

On 4/9/2026, the Department interviewed 1 Witness (W1). W1 states he/she has no issues or concerns with the care that R1 is receiving at the facility.

Review of R1’s physician’s report dated 3/21/2024, R1’s Capacity for Self-Care notes R1 can feed his/her own self.

Review of R1’s care plan dated 8/19/2025, R1 “is on a regular diet and can determine his/her own food choices.

Staff are not meeting residents bathing needs
On 8/26/2025 the Department interviewed the Reporting Party (RP). RP states he/she observed a resident, referred to as R1, for approximately 4 hours on 8/10/2025 and R1 stated facility staff were not bathing him/her.

On 9/18/2025, 4/6/2026 and 4/20/2026 the Department interviewed 4 Staff, (S1 to S4), 3 Residents (R2 to R4), and 1 Witness. 4 Out of 4 staff stated he/she assists residents with bathing/showering. S2 stated the facility has a shower schedule, and residents pick the days and times he/she prefers to bathe/shower.

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SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2026

LIC9099 (FAS) - (06/04)

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Control Number 26-AS-20250813113122

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 SCOTTS VALLEY	FACILITY NUMBER: 445294156
	VISIT DATE: 04/20/2026

NARRATIVE

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S3 states there was one incident when R1 did not want to bathe. S3 did not remember the date or time of this incident.

On 4/20/2026 the Department interviewed 3 Residents (R2 to R4). 3 Out of 3 residents state he/she does not require assistance with bathing/showering. 3 Out of 3 residents state he/she has no issues or concerns with the care he/she is receiving.

On 4/9/2026, the Department interviewed 1 Witness (W1). W1 states he/she has no issues or concerns with the care that R1 is receiving at the facility.

Review of the facility's Weekly Shower Schedule Brookdale Scotts Valley- Personalized Assisted Living, dated Thursday, August 14, 2025, R1 listed on schedule for Mondays at 3PM and Thursdays at 3PM.

Review of R1's progress notes dated 6/13/2025 to 8/14/2025, there are no noted incidents of R1 not wanting to shower/bathe.

Review of R1's Personal Service Plan for R1 dated 3/20/2025, R1 requires physical assistance with shampooing hair, washing upper and lower body.

Staff are leaving residents soiled for an extended period of time.
On 8/26/2025 the Department interviewed the Reporting Party (RP). RP states he/she observed a resident, referred to as R1, for approximately 4 hours on 8/10/2025 and alleges staff are leaving residents soiled for an extended period of time.

On 9/18/2025, 4/6/2026 and 4/20/2026 the Department interviewed 4 Staff, (S1 to S4), 3 Residents (R2 to R4), and 1 Witness. 4 Out of 4 staff stated he/she is not aware of and has not observed a resident left soiled for an extended period of time.

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SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2026

LIC9099 (FAS) - (06/04)

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Control Number 26-AS-20250813113122

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 SCOTTS VALLEY	FACILITY NUMBER: 445294156
	VISIT DATE: 04/20/2026

NARRATIVE

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On 4/20/2026 the Department interviewed 3 Residents (R2 to R4). 3 Out of 3 residents state he/she does not require assistance with toileting. 3 Out of 3 residents state he/she has no issues or concerns with the care he/she is receiving.

On 4/9/2026, the Department interviewed 1 Witness (W1). W1 states he/she has no issues or concerns with the care that R1 is receiving at the facility.

Review of R1’s physician’s report dated 3/21/2024, R1’s Capacity for Self-Care notes R1 can manage his/her own toileting needs, and R1 is not incontinent of bladder.

Review of R1's Personal Service Plan for R1 dated 3/20/2025, R1 does not require toileting assistance.

Although the allegations may have happened or are valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted with ED and a copy of this report was provided to S1.

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END OF REPORT

SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2026

LIC9099 (FAS) - (06/04)

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