<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496802025
Report Date: 07/30/2025
Date Signed: 07/30/2025 11:22:20 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/15/2025 and conducted by Evaluator Robert Frank
COMPLAINT CONTROL NUMBER: 21-AS-20250415140750
FACILITY NAME:BROOKDALE WINDSORFACILITY NUMBER:
496802025
ADMINISTRATOR:KINNEY, JEANNETTEFACILITY TYPE:
740
ADDRESS:907 ADELE DRTELEPHONE:
(707) 837-8785
CITY:WINDSORSTATE: CAZIP CODE:
95492
CAPACITY:80CENSUS: DATE:
07/30/2025
ANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Jeannette Kinney, Executive DirectorTIME COMPLETED:
11:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Unlawful eviction
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
An Office meeting was conducted today, 07/30/2025, in the Santa Rosa Regional Office. LPA Robert Frank delivered investigation findings to Jeannette Kinney, Executive Director.

Licensing Program Analyst (LPA) Robert Frank conducted a complaint investigation regarding the allegations listed above.

The complaint alleges that after the resident (R1) was sent to the hospital on 4/11/2025 for medical issues and that the resident was denied the ability to return to the facility. Complainant indicated the facility did not provide a thirty (30) day eviction notice or seek approval from Community Care Licensing (CCL) to serve a three (3) day notice.

Continued on 9099-C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Robert Frank
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2025
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
Control Number 21-AS-20250415140750
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: BROOKDALE WINDSOR
FACILITY NUMBER: 496802025
VISIT DATE: 07/30/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
...Continued from 9099

During investigation, LPA reviewed Chart Notes. The first Chart Note dated 4/10/2025, 11:30 AM stated that resident R1 was sent to Sutter Hospital Santa Rosa for “dangerous high glucose level”. The charting notes further indicated that R1 was showing signs of anxiety and stress. The 911 call was initiated by R1’s third party Behavior Specialist/BSN (BSN1). The next “Alert Charting Note” text dated 4/10/2025 22:58 states, “Resident called about ten 10 times, requesting to come back to the community. According to the ED, resident isn’t allowed to come back at this time, until they (R1) receive proper treatment, prior to returning”. LPA interviewed Executive Director (ED) Jeannette Kinney at 2:16 PM on 4/22/2025. When asked, “was R1 denied a return to the facility?”, ED Kinney responded, “Yes, we couldn’t control R1’s behaviors.” Based on interviews and review of care plan, R1 transferred from another Brookdale community and their behaviors were known and documented upon admission to Brookdale Windsor.

Based on LPA’s interview, record review and express admission the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 Chapter 8, 87468.2(a)(20) are being cited on the attached 9099D.

Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Exit interview conducted. Copy of report, LIC-9099D, Plan of Corrections, 811 Confidential Names and Appeal Rights discussed and provided to Administrator Kinney. Signature on form confirms receipt of documents

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Robert Frank
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 21-AS-20250415140750
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: BROOKDALE WINDSOR
FACILITY NUMBER: 496802025
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/30/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
07/31/2025
Section Cited
CCR
87468.2(a)(20)
1
2
3
4
5
6
7
Additional Personal Rights of Residents in Privately Operated Facilities(a)In addition to the rights listed in Section 87468.1, ...(20)To be protected from involuntary transfers, discharges, and evictions. A licensee shall not involuntarily transfer or evict... This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Facility to submit an LIC 9098 to Community Care Licensing self certifying that they have reviewed and CCR 87468.2, Additional Personal Rights of Residents in Privately Operated Facilities and CCR 87224 Eviction Procedures by POC due date of 7/31/2025.
8
9
10
11
12
13
14
Based on interview & record review, the licensee did not comply with the section cited above in that resident R1 was not allowed to return to the facility after a hospital emergency room visit which posed an immediate health, safety or personal rights risk to persons in care.
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.
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Robert Frank
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3