Inspection Reports for Brookdale Scotts Valley

The visit was an unannounced Case Management - Other inspection to amend the findings of a previous complaint (26-AS-20250724093244).

During the visit, the Licensing Program Analyst amended the complaint findings from unsubstantiated to unfounded. No deficiencies were cited during this visit.

The visit was related to Complaint 26-AS-20250724093244. The findings were amended from unsubstantiated to unfounded.

An unannounced annual inspection was conducted to evaluate compliance with licensing requirements and facility conditions.

The inspection found no deficiencies cited during the visit. A technical violation related to Centrally Stored Medication and Destruction Records was issued. The facility was found to be in compliance with safety, food storage, medication storage, and emergency preparedness standards.

The visit was an unannounced complaint investigation triggered by allegations received on 2025-01-24 regarding feeding assistance, soiled clothing, and repositioning of a resident.

Based on interviews, document reviews, and observations, there was insufficient evidence to substantiate the allegations. Staff and residents generally reported appropriate care practices, and no deficiencies were cited during the visit.

The complaint alleged that staff did not ensure feeding assistance was provided, allowed a resident to be left in soiled clothing for extended periods, and did not reposition the resident. The investigation found these allegations unsubstantiated due to lack of preponderance of evidence.

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The inspection was an unannounced complaint investigation triggered by allegations received on 2024-12-05 regarding staff response times to call buttons, staff behavior towards residents, medication administration, and meal delivery.

The investigation found that most call buttons were responded to within 15 minutes, with one instance of a 41-minute delay. Allegations of staff yelling at residents and not following doctor's orders for medication were mostly unsubstantiated based on staff and resident interviews. There was some indication that meal delivery did not always occur as agreed, but evidence was insufficient to substantiate violations. No deficiencies were cited.

The complaint was unsubstantiated. Allegations included delayed response to call buttons, staff yelling at residents, lack of dignity in staff-resident relationships, failure to follow doctor's orders for medication, and failure to deliver meals as per admission agreement. Investigations included interviews with staff and residents, random call button testing, and medication record review. Evidence did not support the allegations sufficiently to substantiate violations.

The inspection was an unannounced complaint investigation conducted in response to multiple allegations received on 09/19/2024 regarding visitor restrictions, inappropriate isolation and punishment of residents, medication mismanagement, unqualified staff administering medication, and failure to ensure residents are given showers.

The investigation found all allegations to be either unfounded or unsubstantiated based on interviews with residents, staff, and review of records. No evidence supported visitor restrictions, inappropriate isolation or punishment, medication mismanagement, or unqualified medication administration. The allegation regarding residents not being given showers was unsubstantiated due to inconsistent shower schedules caused by staffing shortages but no neglect was found.

The complaint investigation addressed nine allegations including visitor restrictions, inappropriate isolation and punishment, medication mismanagement, unqualified staff administering medication, and failure to ensure residents are given showers. All allegations were found to be unfounded except the shower allegation which was unsubstantiated.

An unannounced complaint investigation was conducted based on complaints alleging that staff did not notify the authorized representative when a resident went to the hospital and that a resident was left on the floor for an extended period of time.

The investigation found the allegations to be unsubstantiated due to insufficient evidence to prove or disprove the claims. Interviews and record reviews indicated that the resident's responsible party was notified promptly and staff responded to call pendants in a timely manner.

The complaint investigation was triggered by allegations received on October 25, 2023, regarding failure to notify the authorized representative of a hospital visit on August 18, 2023, and a resident being left on the floor for over two hours after a fall in July 2023. The findings were unsubstantiated.

The inspection was conducted as an unannounced complaint investigation following a complaint received on 2025-01-17 alleging that staff were not meeting residents' laundry needs and that laundry machines were in disrepair.

Based on interviews with staff and residents, record reviews, and observations, there was insufficient evidence to substantiate the allegations. Laundry machines were observed to be functioning properly, and laundry service once a week is part of the facility's basic service plan. The allegations were determined to be unsubstantiated and no deficiencies were cited.

The complaint alleged that staff were not meeting residents' laundry needs and that laundry machines were in disrepair. Interviews with staff and residents yielded mixed responses, but overall no preponderance of evidence was found to prove the allegations. The complaint was unsubstantiated.

The visit was an unannounced Case Management Quarterly Visit to ensure the facility is adhering to its Action Plan submitted after an informal meeting on 8/13/2024.

The Licensing Program Analyst reviewed staff training documentation and observed an all staff meeting. The facility is adhering to its Action Plan for staff training, and no deficiencies were cited.

The inspection was an unannounced complaint investigation visit triggered by a complaint received on 2023-07-06 alleging multiple issues including inaccurate resident records, improper wound care, diabetic care deficiencies, failure to respond to calls for help, elopement, hygiene care, laundry service, food service, and pest control.

The investigation substantiated that staff did not maintain accurate medication records for two residents, posing potential health risks. Other allegations such as improper wound care, diabetic care, response to calls for help, elopement prevention, hygiene care, laundry, and food service were found unsubstantiated based on records review and interviews. Pest control services were documented and allegations related to rodents and norovirus outbreak were unsubstantiated.

The complaint investigation was substantiated regarding inaccurate resident medication records for Residents 4 and 5. Other allegations including wound care, diabetic care, response to calls, elopement, hygiene, laundry, food service, and pest control were unsubstantiated.

The inspection was an unannounced complaint investigation visit triggered by allegations that the facility did not have adequate record keeping for a resident, unlawfully evicted a resident, and overcharged a resident for services not received.

The investigation substantiated that the facility failed to maintain proper records for Resident 1, including documentation of service charges, rate increases, and resident discussions, posing potential health, safety, and personal rights risks. The allegation of unlawful eviction was unsubstantiated due to insufficient evidence, and the facility was found to have credited the resident for charges during rehab. The facility did not document resident signatures on updated service plans and inconsistencies were found in invoices and service charges.

The complaint investigation was substantiated regarding inadequate record keeping for Resident 1. The allegation that the facility unlawfully evicted a resident was unsubstantiated due to lack of evidence. The allegation of overcharging a resident for services not received was part of the investigation but not explicitly substantiated or unsubstantiated in the report.

The visit was an unannounced complaint investigation triggered by allegations that facility staff were not responding to residents' call system in a timely manner, the facility did not have sufficient staff to meet residents' needs, and staff were not ensuring proper colostomy care.

The investigation included resident and staff interviews and records review. The allegations were found to be unsubstantiated due to insufficient evidence. No deficiencies were cited. Staff schedules showed adequate staffing levels despite some call-outs. Residents reported generally attentive care.

The complaint involved allegations of delayed response to call lights, insufficient staffing, and inadequate colostomy care. The investigation found no preponderance of evidence to substantiate the allegations. Specific incidents included a colostomy bag explosion and a resident fall related to attempting to catch a mouse, but these were not found to be due to facility negligence.

The visit was an unannounced follow-up to investigate two SOC341 Suspected Adult/Elderly Abuse forms submitted by the facility regarding thefts of residents' belongings.

The investigation revealed that staff member S1 was under local law enforcement investigation for thefts outside the facility, but no proof of theft within the facility was established. Residents R1 and R2 reported missing items, some of which were later found. No deficiencies were cited, but advisory notes were issued.

The visit was complaint-related, following two SOC341 forms alleging theft of residents' valuables. The allegations were investigated, with some items recovered and no confirmed theft within the facility. Staff S1 was suspended pending investigation.

The inspection was an unannounced complaint investigation visit triggered by allegations that a non-medical skilled professional was administering insulin injections to diabetic residents and that staff were not administering residents' insulin as prescribed.

Based on interviews, document reviews, and medication administration records, the allegations were found to be unsubstantiated. Staff nurses were confirmed to be administering insulin as prescribed, and missing medication entries were attributed to computer errors.

The complaint alleged improper insulin administration by non-nurses and missed insulin doses for residents R1 and R2. The investigation included interviews with staff, residents, and review of physician reports and medication records. The findings were unsubstantiated due to lack of preponderance of evidence.

The inspection was an unannounced complaint investigation visit triggered by allegations received on 07/05/2022 regarding rough handling of a resident, inappropriate speech to a resident, and delayed medical attention.

The investigation found insufficient evidence to substantiate the allegations. Although the complaint described an incident involving rough handling causing a skin tear and inappropriate comments by a staff member, and delayed wound care, the facility no longer used the staffing agency involved and records were limited due to the time elapsed. No deficiencies were cited.

The complaint involved allegations that a resident was handled roughly causing a skin tear, spoken to inappropriately, and did not receive timely medical attention. The allegations were unsubstantiated due to lack of preponderance of evidence after attempts to interview the reporting party and review records. The facility no longer used the staffing agency involved and no deficiencies were cited.

The inspection was an unannounced complaint investigation visit triggered by allegations received on 07/05/2022 regarding pest issues in a resident's room and threats to a resident by other residents and staff.

The investigation found no substantiated evidence to support the allegations. Pest control records showed no ant or cockroach activity, and interviews with residents and staff did not confirm threats by other residents or staff. The allegations were deemed unsubstantiated with no deficiencies cited.

The complaint involved allegations that a resident's room had pests, that the resident was threatened by other residents, and that the resident was threatened by staff. Multiple interviews and documentation reviews were conducted, but no preponderance of evidence was found to substantiate the allegations. The complaint was unsubstantiated.

An unannounced complaint investigation visit was conducted following a complaint received on 2023-07-11 regarding allegations that staff did not provide resident's records to the responsible party, did not follow the resident's care plan, and did not give sufficient notice of rate and service increases.

The investigation substantiated the allegations: the facility failed to provide resident records timely to the responsible party, did not follow the resident's care plan resulting in the resident not being ready for a doctor's appointment, and failed to provide written notice prior to increasing rates. Deficiencies were cited under California Code of Regulations Title 22.

The complaint was substantiated. Allegations included failure to provide resident's records to the responsible party, failure to follow the resident's care plan, and failure to provide sufficient notice of rate and service increases. The investigation included interviews, document reviews, and evidence collection confirming these issues.

An unannounced required 1-year annual inspection visit was conducted to evaluate compliance with licensing regulations.

The facility was toured including resident bedrooms, kitchen, and safety equipment. One deficiency was cited for a staff member (S1) lacking a California Criminal Record Clearance after turning 18 years old, posing an immediate health and safety risk. A civil penalty of $500 was assessed for S1 working without clearance for more than 5 days.

The visit was conducted to discuss an incident regarding physiological abuse reported on April 30, 2024, and to follow up on a subsequent case management visit conducted on May 3, 2024.

An informal meeting was held with the facility administrator and district director to discuss the abuse incident and to request an action plan addressing staff training on personal rights, handling residents with Mild Cognitive Impairment (MCI), respecting residents' personal rights, and reassessing residents with MCI. The facility was informed of increased monitoring and use of surveillance cameras.

The visit was complaint-related regarding physiological abuse reported on April 30, 2024. A subsequent case management visit occurred on May 3, 2024. The complaint is under further review with requested corrective actions.

The inspection was an unannounced complaint investigation visit triggered by allegations received on 2024-07-01 regarding staff leaving residents soiled for extended periods, rough handling of residents, yelling at residents, and failure to ensure medication administration.

One allegation regarding staff leaving a resident soiled was substantiated with a deficiency cited for failure to keep incontinent residents clean and dry. Other allegations including rough handling of residents, yelling at residents, and failure to ensure medication administration were unsubstantiated with no deficiencies cited.

The complaint investigation was substantiated for the allegation that staff left resident R3 soiled for an extended period. The other allegations regarding rough handling, yelling, and medication administration were unsubstantiated. Interviews included 7 residents, 6 staff members, and 1 witness. Documentation and observations supported the substantiated finding.

The inspection was an unannounced complaint investigation conducted in response to multiple complaints received on July 5, 2024, alleging that staff did not ensure residents' needs were met, did not safeguard residents' personal items, were not following COVID-19 precautions, handled residents roughly, and did not treat residents with dignity or respect.

The investigation included interviews with staff, residents, and witnesses, as well as facility observations. The department found all allegations to be either unsubstantiated or unfounded, indicating insufficient evidence to prove the complaints. The facility was found to be following infection control protocols during a COVID outbreak, and residents were generally treated with dignity and respect.

The complaint investigation addressed allegations including failure to meet residents' needs (such as missed showers), loss of residents' personal items (laundry), failure to follow COVID-19 precautions, rough handling of residents, and lack of dignity and respect. Interviews with staff and residents revealed mixed reports on shower schedules and laundry, but no conclusive evidence of violations. The COVID outbreak was confirmed, but infection control measures were in place. Allegations of rough handling and disrespect were denied by staff and residents. The findings were unsubstantiated or unfounded.

The inspection was conducted as an unannounced complaint investigation following a complaint received on 2024-03-13 alleging that the licensee was charging a resident for services not provided.

The investigation found that the resident was admitted to a skilled nursing facility and did not return to the facility. The facility reimbursed the resident for care services after 14 days of absence as per the Admission Agreement. The allegation was found to be unfounded with no deficiencies cited.

The complaint alleged that the licensee was charging a resident for services not provided while the resident was hospitalized and admitted to a skilled nursing facility. The investigation included interviews with facility staff and the resident's spouse, and review of billing and admission agreements. The allegation was determined to be unfounded.

The inspection was conducted as an unannounced complaint investigation following an allegation that facility staff coerced a resident to pay for additional services related to medication management.

The investigation found the allegation to be unfounded after interviews and record reviews showed the resident was not capable of managing their own medication and the charges for medication management were appropriate and not coerced.

The complaint alleged that facility staff coerced resident R1 to pay for medication administration when R1 was able to manage medication. The investigation included interviews with staff and the resident, and review of physician reports and medication assessments. The allegation was found to be unfounded.

An unannounced case management-incident visit was conducted regarding a SOC341 report received by the Department alleging psychological abuse by staff.

The Licensing Program Analyst conducted interviews and requested documentation related to the allegations. The incident requires further investigation and the report was reviewed with the facility administrator.

The complaint involved allegations of psychological abuse from staff S1-S4 reported on April 30, 2024. The investigation included interviews with resident R1 and the administrator, and requests for staff licensing and training documents, videos, and resident medical and service records.

An unannounced complaint investigation was conducted in response to a complaint received on 2021-01-05 alleging that staff were not meeting residents' care needs and that a resident was not administered medication as prescribed.

The investigation included interviews and record reviews, but there was insufficient evidence to substantiate the allegations. No deficiencies were cited during the visit.

The complaint was unsubstantiated due to lack of preponderance of evidence to prove the alleged violations did or did not occur.

An unannounced complaint investigation was conducted based on a complaint received on 2021-03-08 alleging improper staff training, understaffing, and failure to follow doctor's orders.

The investigation found no preponderance of evidence to substantiate the allegations. No deficiencies were cited during the visit, and the allegations were deemed unsubstantiated at this time.

The complaint alleged that facility staff had not been trained properly, the facility was understaffed, and staff was not following doctor's orders. The investigation was unable to prove these allegations, resulting in an unsubstantiated finding.

The inspection was an unannounced complaint investigation visit conducted to investigate allegations received on 2023-12-11 regarding COVID mitigation protocol noncompliance, unsanitary kitchen conditions, pest presence, and retention of a resident with a prohibited health condition.

The investigation found that the allegations regarding COVID mitigation, kitchen sanitation, and pest presence were unsubstantiated or unfounded based on staff interviews, observations, and record reviews. No deficiencies were cited. The allegation about retaining a resident with a prohibited health condition (active MRSA) was also unfounded.

The complaint included allegations that the facility did not follow COVID mitigation prevention protocols, staff did not maintain the kitchen in a clean and sanitary condition, staff did not ensure the facility was free of pests, and staff retained a resident with a prohibited health condition (active MRSA). The investigation concluded these allegations were unsubstantiated or unfounded.

The inspection visit was conducted to investigate a complaint received on 2023-12-15 alleging that the facility did not monitor a resident's declining health condition.

The investigation found that the allegations were unfounded. The resident was monitored daily for changes in condition, medication administration, and concerns. Staff interviews and record reviews supported that the facility appropriately monitored the resident until hospital transport.

The complaint alleged failure to monitor a resident's declining health condition. The investigation included interviews with staff and review of resident records. The complaint was determined to be unfounded, meaning the allegations were false or without reasonable basis.

The visit was an unannounced complaint investigation conducted in response to a complaint received on 2023-10-25 alleging that staff did not ensure the facility was free of pests.

The investigation included interviews, record reviews, and observations. The facility had a pest control contract with frequent service visits. Although mice droppings were found in three resident apartments on 2023-08-15, the pest control company applied measures to terminate the pests and the droppings were cleaned. The allegation was determined to be unsubstantiated due to insufficient evidence.

The complaint alleged that staff did not ensure the facility was free of pests. The investigation found no preponderance of evidence to prove the alleged violation occurred, resulting in an unsubstantiated finding.

The inspection was conducted as an unannounced complaint investigation following an allegation that staff admitted a resident with prohibited health conditions.

The investigation found the allegation to be unfounded based on interviews, observations, and document reviews. The resident was assessed and cleared to return to the facility, and their condition improved before moving to a higher level of care.

The complaint alleged that staff admitted a resident with prohibited health conditions. The allegation was found to be unfounded with no preponderance of evidence to support it.

An unannounced complaint investigation visit was conducted in response to allegations that unqualified staff administered medications to residents and that the facility did not provide food of adequate quality and quantity to meet residents' needs.

The investigation found no preponderance of evidence to substantiate the allegations. Interviews with staff and residents did not confirm unqualified medication administration, and residents generally reported adequate food quantity and quality. No deficiencies were cited during this visit.

The complaint was unsubstantiated based on interviews with 10 staff members and 8 residents, medication audits, and record reviews. Residents and staff did not confirm the allegations, and no violations were found.

An unannounced complaint investigation was conducted regarding an allegation that staff did not inform residents when food was delivered.

The investigation found that the facility did not ensure a resident was aware of breakfast delivery, which posed a potential risk to resident health and safety. The allegation was substantiated based on observations and interviews.

The complaint was substantiated based on observations and interviews. The allegation was that staff did not inform residents when food was delivered.

An unannounced complaint investigation was conducted in response to allegations including failure to prevent the spread of a stomach virus, rodent infestation, dishwasher disrepair, and inadequate food service for residents.

The investigation found no evidence to substantiate the allegations. The dishwasher was repaired promptly, no rodent infestation was observed, and infection control practices were largely followed with minor suggestions implemented. Resident and staff interviews supported these findings.

The complaint investigation was unsubstantiated based on observations, interviews, and records review. Although some concerns were noted, there was insufficient evidence to prove violations occurred.

An unannounced complaint investigation was conducted in response to allegations regarding medication mismanagement, inappropriate staff communication, and unmet resident toileting and showering needs.

The investigation found no evidence of medication mismanagement or inappropriate staff behavior towards residents. Residents reported satisfaction with assistance for daily living needs, including showering. One resident reported a delayed response for bathroom assistance, but this could not be verified.

The complaint investigation was unsubstantiated. Allegations included medication mismanagement, inappropriate staff communication, and unmet toileting and showering needs. Interviews, record reviews, and observations did not substantiate these claims.

An unannounced annual inspection was conducted as a required one-year visit to evaluate the facility's compliance with regulations.

The facility was found to be clean, well maintained, and compliant with infection control measures including COVID-19 protocols. No deficiencies were cited during the inspection.

An unannounced complaint investigation was conducted in response to an allegation that facility staff failed to give resident medication as prescribed.

Based on interviews with staff and residents, and review of medication records, the allegation was found to be unsubstantiated. Most residents received medications on time, with one noted 24-hour delay in administering antibiotics, which was not required to be immediate per doctor's order or facility policy.

The complaint alleged failure to give resident medication as prescribed. The investigation included interviews with staff and residents, and review of Medication Administration Records and Medication Delivery Logs. The allegation was determined to be unsubstantiated due to insufficient evidence of violation.

An unannounced site inspection was conducted to ensure the facility had implemented all recommended COVID-19 precautions from previous Department visits and a recent HAI inspection.

The inspection found that the facility had generally implemented COVID-19 precautions including N95 respirator ordering and fit testing, mask wearing by residents, social distancing, and PPE signage, although some issues were noted such as missing N95 masks in one isolation room, incomplete reporting of COVID-19 outbreaks to licensing within 24 hours, and outdated booster vaccination statistics.

The visit was conducted in response to a recent COVID-19 outbreak among residents to assess the facility's compliance with COVID-19 mitigation plans.

The facility was found not to be following the COVID-19 mitigation plan effectively, with issues such as lack of social distancing in the dining hall, insufficient PPE supplies, absence of precautionary signage, and inadequate staff break area separation. Multiple recommendations were made to improve infection control practices.

An unannounced annual inspection was conducted as a required one-year visit to evaluate the facility's compliance with regulations.

The inspection found no deficiencies. The facility was observed to be following COVID-19 safety protocols, including vaccination rates, PPE availability, and visitor policies.

The inspection was an unannounced complaint investigation visit triggered by allegations received on 09/17/2020 regarding neglect to assess a resident's injury, failure to ensure residents were fed, and staff not answering the facility telephone.

The investigation included interviews with 11 residents and 7 staff, review of records, and telephone calls to the facility. The allegations were found to be unsubstantiated or unfounded due to lack of preponderance of evidence. No deficiencies were cited.

The complaint involved multiple allegations: neglect to assess a resident's injury, failure to feed residents during care, and staff not answering the facility telephone. The investigation found that residents were fed during evacuation, staff responded to the resident's injury with first aid and arranged home health care, and staff answered telephone calls. The allegations were determined to be unsubstantiated or unfounded.