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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 445294156
Report Date: 05/07/2026
Date Signed: 05/07/2026 03:08:03 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
05/05/2026 and conducted by Evaluator Marcella Tarin
COMPLAINT CONTROL NUMBER: 26-AS-20260505155121
FACILITY NAME:BROOKDALE SCOTTS VALLEYFACILITY NUMBER:
445294156
ADMINISTRATOR:KUMAR, BEENAFACILITY TYPE:
740
ADDRESS:100 LOCKEWOOD LNTELEPHONE:
(831) 438-7533
CITY:SCOTTS VALLEYSTATE: CAZIP CODE:
95066
CAPACITY:220CENSUS: 167DATE:
05/07/2026
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Executive Director (ED) Alex BaiasuTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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9
Staff did not assist resident after a fall
INVESTIGATION FINDINGS:
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13
Licensing Program Analyst (LPA) Marcella Tarin arrived unannounced to conduct a complaint investigation visit. LPA met with Executive Director (ED) Alex Baiasu. LPA stated the purpose of the visit.

On 5/5/2026 the Department received a complaint alleging that a resident "fell on a Tuesday" and was not assisted by facility staff. No additional information was provided regarding this incident.

On 5/7/2026 the Department interviewed Executive Director (ED), 5 staff and 10 residents. ED states he is not aware of any residents that have fallen and were not assisted by staff.


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Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2026
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-20260505155121
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: 05/07/2026
NARRATIVE
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On 5/7/2026 the Department interviewed 6 Staff (S1 to S6). 6 Out of 6 staff stated he/she is not aware of and has not observed staff not assisting a resident who has fallen.

On 5/7/2026 the Department interviewed 10 residents (R1 to R10). 10 out of 10 residents stated staff assist him/her when needed. 6 Out of 10 residents stated he/she has fallen, and staff assisted him/her when he/she fell. R4 and R9 stated he/she has observed residents fall at the facility, and facility staff helped the residents who fell.

The Department reviewed incident reports submitted from March 2026 to May 2026. There were no reported incidents of staff not assisting residents who had fallen at the facility.

The Department also toured the facility and the facility was observed to be clean, safe, sanitary and in good repair.

The Department reviewed Training Attendance Forms for facility staff to include but not limited to Fall Assessment (1/9/2026), Activating Emergency Services (1/9/2026), Resident Rights (1/30/2026 and 2/27/2026), Reportable Events (4/10/2026), and All Staff Providing Assistance with ADLs (Activities of Daily Living) to Residents (4/10/2026). The Training Attendance forms are signed and dated by facility staff.

This agency has investigated the complaint alleging staff did not assist resident after a fall, we have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted with ED Alex Baiasu and a copy of this report was provided.

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END OF REPORT
SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2026
LIC9099 (FAS) - (06/04)
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