496803339-6-17-2025-21-AS-BMOS-DJ7S5Z-20250702133506

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496803339
Report Date: 06/17/2025
Date Signed: 06/17/2025 02:45:56 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
06/10/2025 and conducted by Evaluator Dina Alviso

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20250610100922

FACILITY NAME:	BROOKDALE PAULIN CREEK		FACILITY NUMBER:	496803339
ADMINISTRATOR:	ALVARADO, ROBERT		FACILITY TYPE:	740
ADDRESS:	2375 RANGE AVE		TELEPHONE:	(707) 575-3722
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95403
CAPACITY:	100	CENSUS:	DATE:	06/17/2025
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Viola Kaake-Executive Director Associate		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility is in disrepair-Elevator doesn't work, and the large dining room has leaks

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alviso conducted a complaint inspection, on 6/17/25 at approximately 1:30pm, and met with Executive Director Associate Viola Kaake.
Reporting party alleges that "facility elevator in independent living (IL) doesn't work, and the large dining room in independent living (IL) area has leaks ". LPA conducted interviews with staff, S1 and S2, and other related parties. The investigation revealed that the licensed assisted living area has no leaks in the hallways and/or in the dining room areas. LPA obtained information that the elevator has been repaired in IL, and there is a second elevator on the floorfor use as well. The independent living dining room has no leaks, but is scheduled for roof renovations needed from leaks that occurred during the rainy season. The independent living areas are not part of the licensed assisted living portion of the facility property. The Department has no jurisdiction over the "independent living" portion of the large building. Based on interviews, LPA's observations, and information obtained during the investigation, the allegations "facility elevator doesn't work, and the large dining room has leaks" are Unfounded. We have found that the complaint allegation(s) were 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: 06/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025

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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