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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496803241
Report Date: 03/05/2025
Date Signed: 03/05/2025 03:53:28 PM

Substantiated


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
01/27/2025 and conducted by Evaluator Christi Coppo
COMPLAINT CONTROL NUMBER: 21-AS-20250127104841
FACILITY NAME:BROOKDALE CHANATEFACILITY NUMBER:
496803241
ADMINISTRATOR:ALVARADO, ROBERTFACILITY TYPE:
740
ADDRESS:3250 CHANATE RDTELEPHONE:
(707) 575-7503
CITY:SANTA ROSASTATE: CAZIP CODE:
95404
CAPACITY:140CENSUS: DATE:
03/05/2025
UNANNOUNCEDTIME BEGAN:
10:52 AM
MET WITH:Robert AlvaradoTIME COMPLETED:
04:07 PM
ALLEGATION(S):
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Staff does not respond to pendant call system timely
Staff left resident in soiled incontinence briefs for an extended period of time
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christi Coppo arrived at this facility deliver complaint findings on the above allegation. LPA met with Administrator Robert Alvarado.

Complaint alleges staff does not respond to pendant call system timely. Complaint alleges that facility is short-staffed and so do not provide timely care. Per California Title 22, RCFEs do not have staffing ratios and staffing is dependant on residents' needs, so a determination that a facility is short-staff is determined by whether or not residents' needs are being met. At this facility, the method by which residents alert staff that they need help with care or require assistance is through a pendant call button system. Each resident is assigned a pendant. When a resident needs help or assistance with a care need, they push the button on their pendant in order to alert staff to their need. During investigation, LPA review of pendant log shows that between 2/9/25 and 2/13/25 residents pushed their pendant call buttons 192 times.

Continued on 9099C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2025
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 4
Control Number 21-AS-20250127104841
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 CHANATE
FACILITY NUMBER: 496803241
VISIT DATE: 03/05/2025
NARRATIVE
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Continued from 9099...

Of those 192 times, the wait time until someone arrived to help were:
· 41 waited between 15 minutes and 30 minutes,
· 17 waited between 30 minutes and 44 minutes, and
· 42 never got a response

Additionally, on average, the residents pressed their pendant call button between 4-9 times on each occurrence of pressing it. Administrator advised they are actively working with staff to bring response times down and address the needs of residents in a timely manner. Based on LPA interview and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 Chapter 8, are being cited on the attached 9099D.

Complaint alleges staff left resident in soiled incontinence briefs for an extended period of time. During investigation, LPA interviewed eight [8] residents. Of the eight residents interviewed, two [2] residents wear incontinence briefs and require staff assistance to manage and change their briefs. Both residents report that they have have to wait long periods of time before staff arrives to change their briefs. Both residents report that on least two occasions they waited over an hour for staff to arrive, after they notified staff they needed to be changed. Based on LPA interview, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 Chapter 8, are being cited on the attached 9099D.

Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given and discussed with Administrator. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties.

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

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
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
01/27/2025 and conducted by Evaluator Christi Coppo
COMPLAINT CONTROL NUMBER: 21-AS-20250127104841

FACILITY NAME:BROOKDALE CHANATEFACILITY NUMBER:
496803241
ADMINISTRATOR:ALVARADO, ROBERTFACILITY TYPE:
740
ADDRESS:3250 CHANATE RDTELEPHONE:
(707) 575-7503
CITY:SANTA ROSASTATE: CAZIP CODE:
95404
CAPACITY:140CENSUS: DATE:
03/05/2025
UNANNOUNCEDTIME BEGAN:
10:52 AM
MET WITH:Robert AlvaradoTIME COMPLETED:
04:07 PM
ALLEGATION(S):
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Personal rights
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christi Coppo arrived at this facility deliver complaint findings on the above allegation. LPA met with Administrator Robert Alvarado.

Complaint alleges staff are rough with residents and treat them in a rough manner when providing care, resulting in or causing them pain. During investigation, LPA interviewed eight [8] residents. Eight [8] out of 8 [8] residents report that staff are nice and friendly. Seven [7] out of eight [8] residents report that staff have never yelled at them and they have never seen staff yell at other residents. Seven [7] out of eight [8] residents report that staff have never pushed them, grabbed them, or hurt them when providing care. 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.



Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 21-AS-20250127104841
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 CHANATE
FACILITY NUMBER: 496803241
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/05/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/12/2025
Section Cited
HSC
1569.269
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§1569.269 Enumerated rights... a)Residents...shall have all of the following rights:(6) To care, supervision, and services that meet their individual needs...delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs.
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Facility to ensure that pendant call button system is in good repair and operational, staff is sufficient to answer calls in a timely manner, when residents are in need of assistance. Facility to submit three day pendant call button system log to CCL showing all calls answered
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This requirement was not met by licensee as evidenced by: Based on LPA record review of facility's pendant call button system log, the licensee did not comply with the section cited above in that between 2/9/25 and 2/13/25 residents pushed their pendant call button at least 192 times. Of those 192 times at least 42 never got a response, which poses a potential health, safety or personal rights risk to persons in care.
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within a timely manner by plan of correction due date. Admin agrees that within 10-12 minutes can be defined as within a timely manner.
Type B
03/26/2025
Section Cited
CCR
87625(b)(3)
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87625 Managed Incontinence (b) In addition to Section 87611... the licensee shall be responsible for the following:(3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. This requirement was not met by licensee as evidenced by:
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Facility to conduct resident rights training for all care staff providing direct care to residents. Training to be at least one hour in duration and completed no later than 3/26/25.
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Based on LPA interviews of facility's pendant call button system log, the licensee did not comply with the section cited above in that two [2] out of [2] residents that require staff assistance to manage and change their briefs waited long periods of time before staff arrived to change them, on least two occasions they waited over an hour, hich poses a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4