496803241-9-3-2021-21-AS-HDBI-C75TLY-20210923145016

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496803241
Report Date: 09/03/2021
Date Signed: 09/03/2021 12:38:09 PM

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
07/14/2021 and conducted by Evaluator Victoria Willis

COMPLAINT CONTROL NUMBER: 21-AS-20210714145837

FACILITY NAME:	BROOKDALE CHANATE		FACILITY NUMBER:	496803241
ADMINISTRATOR:	CORTES, MARIA		FACILITY TYPE:	740
ADDRESS:	3250 CHANATE RD		TELEPHONE:	(707) 575-7503
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95404
CAPACITY:	140	CENSUS: 65	DATE:	09/03/2021
		UNANNOUNCED	TIME BEGAN:	12:20 PM
MET WITH:	Administrator, Maria Cortes		TIME COMPLETED:	12:50 PM

ALLEGATION(S):

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Staff member inappropriately handled resident in care.
Staff member left resident on the floor after pulling her out of bed.
Staff member verbally threatened resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst Willis arrived unannounced to deliver finding regarding the above complaint allegations and met with Administrator, Maria Cortes.

During investigation. LPA conducted interviews and reviewed documents. Complaint alleges that a facility staff forcibly pulled a resident from bed and left them on the ground. Additionally, the complaint alleges that the staff is “mean” to the resident, threatens them and handles them roughly. Information obtained from interviews and document review was not always consistent with the alleged incident date changing as well as the people involved. Based on police report obtained, a physical exam was done of the resident following the alleged incident and no bruising or swelling was observed. Staff deny yelling at residents or treating them roughly.

A finding that the complaint allegations that a staff member inappropriately handled resident in care, left resident on the floor after pulling them out of bed and verbally threatened resident 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.

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: 09/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2021

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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