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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 445294156
Report Date: 04/20/2026
Date Signed: 06/09/2026 02:25:31 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
11/18/2025 and conducted by Evaluator Marcella Tarin
COMPLAINT CONTROL NUMBER: 26-AS-20251118161725
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:
04/20/2026
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Executive Director (ED) Alex BaiasuTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Staff do not ensure resident's incontinence care needs are being met.
Resident fell while in care due to lack of staff supervision.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced complaint investigation visit to deliver complaint findings. LPA met with Executive Director (ED) Alex Baisu. LPA stated the purpose of the visit.

On 11/18/2025 the Department received a complaint with the above allegations

On 11/19/2025 the Department interviewed the Reporting Party (RP). RP states a resident, referred to as R1, was left in a soiled brief between 10/01/2025 - 11/18/2025 due to staff not meeting R1’s incontinence needs. RP stated he/she was "not so concerned with R1's incotinence care." R1 did not provided additional information regarding these incidents.

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Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2026
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 3
Control Number 26-AS-20251118161725
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: 04/20/2026
NARRATIVE
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On 11/19/2025 and 4/20/2026 the Department conducted complaint investigation visits and interviewed 4 Staff (S1 to S4), 4 Residents (R1 to R4) and 1 Witness. 4 Out of 4 staff state he/she is not aware of and has not observed a resident left in a soiled brief. S2 states R1 preferred to change his/her own brief.

On 11/19/2025 and 4/20/2026 The Department interviewed 4 Residents (R1 to R4). 3 Out of 4 Residents stated he/she does not require any assistance with toileting. 3 Out of 4 Residents state he/she does not have any issues or concerns with the care he/she is receiving. R1 did not respond to questions due to cognitive impairment.

On 11/19/2025 the Department interviewed 1 Witness (W1). W1 states he/she has worked with R1 for approximately six months. W1 states he/she has not observed R1 left in a soiled brief due to staff not attending to residents’ incontinence needs.

Review of R1’s physician’s report dated 2/8/2024, R1 is noted to have bladder impairment. R1 is also unable to care for his/her own toileting needs and needs assistance with toileting.

Review of R1’s care plan dated 10/22/2025, R1 is noted to not require bathroom assistance, “can manage his/her own bathroom needs at this time.”

Review of R1's progress notes from 5/1/2025 to 11/29/2025, there are no noted incidents of R1 being left soiled by facility staff.
Resident fell while in care due to lack of staff supervision
On 11/19/2025 the Department interviewed the Reporting Party (RP). RP states a resident, referred to as R1, had four falls during between May 2025 to November 2025 due to lack of staff supervision. RP stated the facility informed him/her about these incidents of R1 falling.

On 11/19/2025 the Department interviewed 1 Witness (W1). W1 states he/she has worked with R1 for approximately six months.


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SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 26-AS-20251118161725
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: 04/20/2026
NARRATIVE
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W1 states R1 had four falls during these six months (May 2025 to November 2025). W1 states R1 was checked frequently by facility staff during the time the falls occurred. W1 stated R1 is ambulatory and uses a wheelchair and can self-transfer (to and from the wheelchair). W1 states he/she does not believe R1 fell due to staff neglect.

Review of R1’s physician’s report dated 2/8/2024, R1 is noted to have motor impairment/paralysis, walks with a cane.’ R1 is non-ambulatory due to physical condition.

Review of R1's progress notes from 5/1/2025 to 11/29/2025, R1 is being checked on by facility staff with noted incidents of R1 falling on 11/14/2025, 10/24/2025, 9/22/2025, and 5/6/2025. R1 was assessed by facility staff, and all responsible parties were notified of the falls.

Review of R1’s care plan dated 10/22/2025, for ‘Escort & Mobility’ R1 is noted as “independent going to and from the dining room or community activities, resident has falls in the last twelve months, resident has fallen without apparent harm/injury, resident uses a cane as a mobility aid, resident uses a walker as a mobility aid, resident uses a manual wheelchair as a mobility aid."

Although the allegations may have happened or are valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted with ED and a copy of this report was provided.

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END OF REPORT

SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2026
LIC9099 (FAS) - (06/04)
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