496802025-5-30-2025-21-AS-VBEI-DHDT9C-20250606143143

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496802025
Report Date: 05/30/2025
Date Signed: 05/30/2025 11:43:02 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/27/2025 and conducted by Evaluator Christi Coppo

COMPLAINT CONTROL NUMBER: 21-AS-20250227092720

FACILITY NAME:	BROOKDALE WINDSOR		FACILITY NUMBER:	496802025
ADMINISTRATOR:	KINNEY, JEANNETTE		FACILITY TYPE:	740
ADDRESS:	907 ADELE DR		TELEPHONE:	(707) 837-8785
CITY:	WINDSOR	STATE: CA	ZIP CODE:	95492
CAPACITY:	80	CENSUS:	DATE:	05/30/2025
		UNANNOUNCED	TIME BEGAN:	10:23 AM
MET WITH:	Jeanette Kinney, Administrator		TIME COMPLETED:	11:57 AM

ALLEGATION(S):

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Medications not dispensed as prescribed

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to deliver findings regarding the above allegation and met with Jeanette Kinney, Administrator.

Complaint alleges facility did not dispense medications as prescribed. Complainant states on 2/20/25 resident ( R1) was discharged from a facility to Brookdale Windsor. On 2/18/25 Brookdale Windsor Health and Wellness Director, Tina Worton (HWD) received a copy of discharge instructions and medications for R1. However, HWD was not present at the facility on 2/20/25 or 2/21/25 and so R1’s medications from discharge were not added to their current medications list, resulting in R1 not receiving their updated medication.

During investigation, LPA reviewed staffing schedule for facility. Schedule shows that HWD was off duty on 2/20/25 and 2/21/25. During investigation, LPA conducted interviews. Staff indicated to LPA that the

Continued on 9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2025

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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Control Number 21-AS-20250227092720

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: BROOKDALE WINDSOR	FACILITY NUMBER: 496802025
	VISIT DATE: 05/30/2025

NARRATIVE

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Continued from 9099...

procedure when processing a medication change or new medication is to first obtain signed doctor’s orders before faxing to Consonus, whether or not HWD is present at facility. LPA also reviewed medication list and MAR for R1. LPA reviewed start dates of medications identified on discharge papers to be administered daily. List shows medications ordered on 2/20/25 but not given until 2/21/25 or 2/23/25 for Atorvastatin and Salon Pas. However, during investigation, LPA was provided copies of Brookdale's Pharmacy Service Agreement and the Consonus Pharmacy Customer Agreement signed by R1’s responsible party. Noted on the Consonus Pharmacy Customer Agreement is a handwritten addition indicating that Brookdale would only use Consonus for R1 in the cases of over-the-counter medication or urgent/emergency medications. Admin clarified with LPA that even in the cases of using Consonus for urgent medications, Brookdale must still provide the family with an opportunity to provide Brookdale the medication even though they signed the Consonus Pharmacy Customer Agreement. Admin advised Brookdale still must wait the two [2] days indicated in the Pharmacy Service Agreement, because some people don’t have a co-pay through their own pharmacy such as the V.A. and/or Kaiser, but through Consensus they have to pay a shared cost.
Per LPA record review and interview, there was delay in R1 receiving the new medications prescribed at discharge; however, it is unclear if the facility was following their written protocol, allowing the responsible party to obtain the prescription prior to using Consonus or if there was a delay due to the absence of the HWD. So, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Note: LPA clarified protocols with facility to ensure there are not unnecessary delays in the future with residents’ medications being administered timely.

Exit interview conducted with Administrator and a copy of this report given.

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2025

LIC9099 (FAS) - (06/04)

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