397005466-10-7-2025-27-AS-LKIG-DMESM3-20251013135916

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 397005466
Report Date: 10/07/2025
Date Signed: 10/07/2025 10:19:46 AM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/03/2025 and conducted by Evaluator Kesha Lewis

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20251003102613

FACILITY NAME:	BROOKDALE KETTLEMAN LANE		FACILITY NUMBER:	397005466
ADMINISTRATOR:	MARY MARGARET CHAPPELL		FACILITY TYPE:	740
ADDRESS:	2150 W KETTLEMAN LN		TELEPHONE:	(209) 333-8033
CITY:	LODI	STATE: CA	ZIP CODE:	95242
CAPACITY:	56	CENSUS: 44	DATE:	10/07/2025
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Nicole Bacon		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Facility does not employ adequate staff to meet the residents' needs.
Residents do not received assistance from staff in a timely manner.
Residents are left in soiled for extended period of time.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kesha Lewis arrived at the facility unannounced to open a complaint for the above allegations. LPA was greeted by staff and explained the reason for the visit.

Based on the information provided by the reporting party and the actual rooms in the facility this can not be a correct facility. There is a discrepancy in the room numbers provided in the complaint to the rooms that are in the facility. LPA did not observe a preponderance of evidence standard therefore the allegations are UNFOUNDED. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies are being cited.

“This agency has investigated the complaint alleging the above mentioned allegations. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.”

An exit interview was held, and a copy of this report was given.

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2025

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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