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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 075601300
Report Date: 02/25/2026
Date Signed: 02/25/2026 04:35:50 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/16/2025 and conducted by Evaluator Tonica Syess-Gibson
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20251216091603
FACILITY NAME:BRENTWOOD ASSISTED LIVING, LLCFACILITY NUMBER:
075601300
ADMINISTRATOR:AGUSTIN SAMANIEGOFACILITY TYPE:
740
ADDRESS:450 JOHN MUIR PKWYTELEPHONE:
(925) 516-8006
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY:200CENSUS: 122DATE:
02/25/2026
UNANNOUNCEDTIME BEGAN:
09:48 AM
MET WITH:Scott Shahade, Executive Director TIME COMPLETED:
04:53 PM
ALLEGATION(S):
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Licensee did not ensure staff provided adequate meals to residents
INVESTIGATION FINDINGS:
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On 02/25/2026 at 09:48AM, Licensing Program Analyst (LPA) T. Syess-Gibson arrived unannounced to investigate and deliver complaint findings for the allegations above in regard to the allegation above. LPA met with Executive Director, Scott Shahade, and explained the purpose of visit.

During the course of the investigation, LPA interviewed witness, staff and residents. LPA reviewed and obtain the following documents,: Resident roster, resident’s dining comment cards and facility’s breakfast, lunch and dinner menus for the month of December 2025.

Continue on LIC9099C....
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2026
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 2
Control Number 15-AS-20251216091603
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: BRENTWOOD ASSISTED LIVING, LLC
FACILITY NUMBER: 075601300
VISIT DATE: 02/25/2026
NARRATIVE
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Continued from LIC9099


Allegation: Licensee did not ensure staff provided adequate meals to residents

Based on interviews with S2, R1, R3, R4, it was revealed food is not served cold. Interviews also revealed, food has not been served undercooked. Record review revealed residents were given comment cards for a month of December 2025 for the chef regarding food and food services. The comment cards received back from residents have more positive than negative comments.


Based upon the information obtained during investigation. The above allegations are unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.


Exit interview conducted and a copy of report was given.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2