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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 445294156
Report Date: 04/04/2025
Date Signed: 04/04/2025 04:18:24 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/17/2025 and conducted by Evaluator Marcella Tarin
PUBLIC
COMPLAINT CONTROL NUMBER: 26-AS-20250117115850
FACILITY NAME:BROOKDALE SCOTTS VALLEYFACILITY NUMBER:
445294156
ADMINISTRATOR:KUMAR, BEENAFACILITY TYPE:
740
ADDRESS:100 LOCKEWOOD LNTELEPHONE:
(831) 438-7533
CITY:SCOTTS VALLEYSTATE: CAZIP CODE:
95066
CAPACITY:220CENSUS: 162DATE:
04/04/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Executive Director Alex BaiasuTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Staff are not meeting resident's laundry needs
Staff did not ensure laundry machines were not in disrepair
INVESTIGATION FINDINGS:
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On 1/17/2025 the Department received a complaint alleging that staff are not meeting resident’s laundry needs and staff did not ensure laundry machines were not in disrepair.

On 1/25/2025 LPAs interviewed Witness 1 (referred to as W1). W1 stated he/she can’t say for sure if the facility failed to do the laundry twice a week. W1 stated he/she was doing laundry and went upstairs, and one of the laundry machine/dryers was not turning on, but eventually turned on. W1 stated he/she may not have known how to operate the laundry machine/dryer and is unsure if the laundry machine/dryer was in disrepair.

On 1/23/2025, LPAs Marcella Tarin and David Maruffo conducted the initial complaint investigation. LPAs interviewed 6 staff (referred to as S1-S6), and residents (referred to as R1-R5) regarding the above allegations.
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Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jin Jackie
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 04/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2025
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 3
Control Number 26-AS-20250117115850
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME: BROOKDALE SCOTTS VALLEY
FACILITY NUMBER: 445294156
VISIT DATE: 04/04/2025
NARRATIVE
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4 Out of 6 staff (S1-S3, S6) state the laundry machines were not in disrepair. 2 out of 6 staff (S4 & S5) state that yes, the laundry machines have been in disrepair (broken/not working) and were replaced on the same day by the facility.

LPA interviewed 5 residents. 5 Out of 5 residents state the laundry machines were not in disrepair. 3 Out of 5 residents state staff are meeting his/her laundry needs. 2 Out of 5 residents state staff are not meeting his/her laundry needs. R1 and R2 state there has been instances when his/her laundry was not returned the same day during his/her scheduled laundry day.

LPAs interviewed the Administrator regarding the allegations. ADM states laundry service once a week is part of the facility’s basic service plan for all residents. ADM states that laundry machines (Washers/dryers) have broken down (not working) but that maintenance will repair or replace the laundry machines.

During visit LPAs observed 15 washers and 15 dryers in 9 laundry rooms throughout the facility. All 15 washers and 15 dryers functioned properly when tested by staff.

On 4/4/2025, LPAs interviewed 4 residents (R6-R9). All residents interviewed stated he/she has no issue with laundry service. All residents interviewed states he/she is not aware of laundry machines being in disrepair.

Based on record review, the facility's resident admission agreement state that laundry service once a week is part of the facility’s basic plan for all residents.

LPAs also reviewed the Weekly Laundry Schedule and R1-R9 are listed on the schedule for weekly laundry service.


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SUPERVISORS NAME: Jin Jackie
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 04/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 26-AS-20250117115850
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME: BROOKDALE SCOTTS VALLEY
FACILITY NUMBER: 445294156
VISIT DATE: 04/04/2025
NARRATIVE
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Based on information from interviews conducted with staff, records reviewed and observation, although the allegations listed above may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Therefore, the allegations are UNSUBSTANTIATED.

No Deficiencies were cited under California Code of Regulations Title 22. This report was reviewed with Executive Director Alex Baiasu and a copy of this report was provided.

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SUPERVISORS NAME: Jin Jackie
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 04/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3