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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496803339
Report Date: 06/16/2022
Date Signed: 06/16/2022 05:02:40 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
04/08/2022 and conducted by Evaluator Dina Alviso
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20220408134007
FACILITY NAME:BROOKDALE PAULIN CREEKFACILITY NUMBER:
496803339
ADMINISTRATOR:ALVARADO, ROBERTFACILITY TYPE:
740
ADDRESS:2375 RANGE AVETELEPHONE:
(707) 575-3722
CITY:SANTA ROSASTATE: CAZIP CODE:
95403
CAPACITY:100CENSUS: DATE:
06/16/2022
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Robert Alvarado-AdministratorTIME COMPLETED:
05:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident is not allowed to have visitors
Resident doesn't have telephone access
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Dina conducted a complaint inspection, and met with Robert Alvarado, Executive Director/Administrator. During this investigation, resident records were reviewed on resident R1 & R2,, interviews were conducted with staff and resident, and copies of documents were obtained. The investigation revealed that residents were allowed visitors, and per interviews, R1 made clear to the LPA that they see who they want to see, they make the decision on who they want to visit with. Specific information on visitors and visitation were provided and stated to the LPA during this interview. Residents have a telephone hooked up in their apartment and the residents also had a cell phone in their possession for taking calls and/or making calls. Residents were not left without access to phone service use. The cell phone remained in the apartment unit with the residents at all times. Facility staff had observed the cell phone in the unit, and also stated the unit has a telephone line/phone that works. Facility staff stated to the LPA that they have allowed the visitors that were said by "the residents" that they could go and visit with them.
Based on the interviews, record/document reviews, and related information obtained during the investigation, the allegations of "resident is not allowed to have visitors, and resident doesn't have telephone access" are Unfounded.
The Department has found that the complaint allegation was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. Exit interview conducted. No violations/No deficiencies cited.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Dina AlvisoTELEPHONE: (707) 588-5082
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022
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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