496802025-2-2-2021-21-AS-HDBI-BYB2BG-20210216161506

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496802025
Report Date: 02/01/2021
Date Signed: 02/02/2021 10:03:23 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/09/2020 and conducted by Evaluator Victoria Willis

COMPLAINT CONTROL NUMBER: 21-AS-20200909143312

FACILITY NAME:	BROOKDALE WINDSOR		FACILITY NUMBER:	496802025
ADMINISTRATOR:	WATSON, WENDY		FACILITY TYPE:	740
ADDRESS:	907 ADELE DR		TELEPHONE:	(707) 837-8785
CITY:	WINDSOR	STATE: CA	ZIP CODE:	95492
CAPACITY:	80	CENSUS: 49	DATE:	02/01/2021
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Administrator, Wendy Watson		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Facility failed to readmit resident in a timely manner upon discharge from the hospital

INVESTIGATION FINDINGS:

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Licensing Program Analyst Willis met with Administrator, Wendy Watson to deliver findings regarding the complaint allegation. Visit was done remotely to observe Covid-19 Precautions.
Complaint alleges that facility refused to accept a resident back to the facility when they were released by the hospital. Based on interviews, facility was sending Covid positive residents to a skilled nursing facility or a facility designated for Covid regardless of the presence of or severity of their symptoms. Interviews indicate that this was standard practice for the facility and the transfer to the skilled nursing facility was not presented to the families as voluntary.
The allegation that facility failed to readmit resident in a timely manner upon discharge from the hospital is Substantiated. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.
Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Victoria Willis	TELEPHONE: (707) 588-5087
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/09/2020 and conducted by Evaluator Victoria Willis

COMPLAINT CONTROL NUMBER: 21-AS-20200909143312

FACILITY NAME:	BROOKDALE WINDSOR		FACILITY NUMBER:	496802025
ADMINISTRATOR:	WATSON, WENDY		FACILITY TYPE:	740
ADDRESS:	907 ADELE DR		TELEPHONE:	(707) 837-8785
CITY:	WINDSOR	STATE: CA	ZIP CODE:	95492
CAPACITY:	80	CENSUS: 49	DATE:	02/01/2021
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Administrator, Wendy Watson		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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9

Insufficient staffing

INVESTIGATION FINDINGS:

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Licensing Program Analyst Willis met with Administrator, Wendy Watson to deliver findings regarding the complaint allegation. Visit was done remotely to observe Covid-19 Precautions.

Complaint alleges that Covid positive residents were transferred out because the facility did not have sufficient staffing. Based on interviews, the reason for sending out Covid positive residents was not necessarily based on staffing.

A finding that the complaint allegation that facility has insufficient staffing was unsubstantiated meaning that although the allegation may have happened there is not a preponderance of evidence to prove that the allegation occurred. We have therefore dismissed the complaint.

No deficiencies cited.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Victoria Willis	TELEPHONE: (707) 588-5087
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 21-AS-20200909143312

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: BROOKDALE WINDSOR	FACILITY NUMBER: 496802025
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/01/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed Type A 02/02/2021 Section Cited HSC 1569)a)(22)	1 2 3 4 5 6 7	1569.269 Enumerated rights; severability (a) Residents of RCFEs shall have all of the following rights: (22)To be protected from involuntary transfers,discharges & evictions in violation of state laws & regulations. Facilities shall not involuntarily transfer or evict residents for grounds other than those	1 2 3 4 5 6 7	Administrator has submitted the LIC808 Mitigation Plan showing that Covid + residents will be quarantined per PIN 20-38ASC. Deficiency is cleared.
	8 9 10 11 12 13 14	specifically enumerated under state law or regulations & shall comply with enumerated eviction & relocation protections for residents. Regulation has not been met based on interviews showing that Covid Positive residents were transferred out of facility regardless of symptoms.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Victoria Willis	TELEPHONE: (707) 588-5087
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2021

LIC9099 (FAS) - (06/04)

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