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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496803339
Report Date: 02/13/2025
Date Signed: 02/13/2025 01:00:52 PM

Unfounded


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
02/05/2025 and conducted by Evaluator Dina Alviso
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20250205085245
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:
02/13/2025
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Robert Alvarado-AdministratorTIME COMPLETED:
01:05 PM
ALLEGATION(S):
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Facility ceilings in the dining room are in disrepair
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alviso conducted a complaint inspection, on 2/13/25 at approximately 9:45am, and met with Administrator Robert Alvarado.
Reporting party alleges that "facility ceilings in the dining room are in disrepair". LPA toured the assisted living facility, and toured the large dining room area in the independent living portion of the building. LPA conducted interviews with staff, S1, and other related parties. The investigation revealed that the licensed assisted living area has a total of three (3) dining rooms, two of these are in the memory care area. LPA observed that none of these, three (3), dining rooms had leaks and/or openings in the ceilings. LPA observed that the large independent dining room has openings in the ceilings, and has leaks that can't be repaired till the rain stops, per interviews with staff, S1. The independent living dining room is not part of the licensed assisted living portion of the facility. The Department has no jurisdiction over the independent living dining room and/or independent living areas of the building.
Based on interviews, LPA's observations, and information obtained during the investigation, the allegation "facility ceilings in the dining room are in disrepair" is Unfounded. We have found that the complaint allegation(s) was Unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.
No deficiencies cited.
Exit interview was conducted with the Administrator.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2025
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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