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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306002954
Report Date: 06/11/2025
Date Signed: 06/11/2025 01:17:53 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/17/2023 and conducted by Evaluator Celine Rodriguez
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230817142044
FACILITY NAME:BROOKDALE IRVINEFACILITY NUMBER:
306002954
ADMINISTRATOR:CARRIE GALLOWAYFACILITY TYPE:
740
ADDRESS:10 MARQUETTETELEPHONE:
(949) 854-3766
CITY:IRVINESTATE: CAZIP CODE:
92612
CAPACITY:155CENSUS: 146DATE:
06/11/2025
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Sharin Belanger - Business Office ManagerTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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9
Facility staff did not handle resident properly resulting in injury.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Celine Rodriguez conducted an unannounced visit to the facility to deliver the findings. LPA Rodriguez explained the purpose of today's visit and was greeted by business office manager (BOM) Sharin Belanger.

It was alleged that facility staff did not handle resident properly resulting in injury. Six interviews were conducted with staff and residents, of which all six interviews did not corroborate with the allegation. Interviews conducted with resident 1 (R1) stated that staff are friendly and helpful, and verified that staff never handled R1 in a way that resulted in injury. Per record review, R1 is not diagnosed with dementia or cognitive impairment and during R1's hospitalization, R1 was placed on blood thinners, and was informed that R1 would be more prone to bruising. Record review also revealed that R1 requires assistance getting to and from the wheelchair, to which R1 confirmed that staff will utilize a gait belt, and denied of staff grabbing R1's wrists and arms to move. R1 was observed to have bruises on the arm, however confirmed that it was due to receiving an IV at the hospital and being on blood thinner medication.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Celine Rodriguez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2025
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 22-AS-20230817142044
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: BROOKDALE IRVINE
FACILITY NUMBER: 306002954
VISIT DATE: 06/11/2025
NARRATIVE
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Based on LPA’s interviews which were conducted, review of documents obtained, and observations, LPA is unable to ascertain if the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed UNSUBSTANTIATED.

An exit interview was conducted with BOM Belanger.

A copy of this report was explained and provided during the visit.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Celine Rodriguez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2