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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496802025
Report Date: 10/02/2026
Date Signed: 10/02/2026 12:40:19 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
09/28/2026 and conducted by Evaluator Robert Frank
COMPLAINT CONTROL NUMBER: 21-AS-20260928090626
FACILITY NAME:BROOKDALE WINDSORFACILITY NUMBER:
496802025
ADMINISTRATOR:KINNEY, JEANNETTEFACILITY TYPE:
740
ADDRESS:907 ADELE DRTELEPHONE:
(707) 837-8785
CITY:WINDSORSTATE: CAZIP CODE:
95492
CAPACITY:80CENSUS: 64DATE:
10/02/2026
UNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Tina Worden, Health & Wellness DirectorTIME COMPLETED:
12:50 PM
ALLEGATION(S):
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Facility doors are not in good repair
INVESTIGATION FINDINGS:
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At approximately 9:55 AM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to initiate and deliver findings for a Complaint Investigation regarding the above allegation and met with facility Health & Wellness Director (HWD) Tina Worden.

During the course of the investigation LPA conducted a facility visit and conducted interviews.

Complaint alleges that the facility doors are not in good repair. The reporting party (RP) stated that the main front doors of the facility are not locking shut when they close during nighttime hours. The facility keeps the front doors locked from 7:30 PM to 7:00 AM when there is not an employee at the front desk. The doors in question are capable of automatically opening and closing. LPA tested the doors multiple times during today’s inspection.

Continued on 9099-C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Robert Frank
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2026
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 21-AS-20260928090626
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: 10/02/2026
NARRATIVE
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...Continued from 9099

LPA observed that the doors do not securely lock when they close. LPA was required to push or pull (depending on LPA being inside or outside) the doors in order for the latch to catch, thereby locking the doors. Staff member S1 concurred stating that, “you do need to push on it to latch.” During an interview, witness W2 stated that the front doors have not been locking correctly for, “some time now, maybe a year. It's a security concern.” Based on LPA’s observations, interviews and express admission 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.

Exit interview conducted. Copy of report, LIC-9099, LIC-9099C, LIC-9099D, Plan of Corrections and Appeal Rights discussed and provided to HWD Worden. Signature on form confirms receipt of documents.
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Robert Frank
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 21-AS-20260928090626
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/02/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/30/2026
Section Cited
CCR
87303(a)
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87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.
This requirement is not met as evidenced by:
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Licensee is to fix the front doors of the facility so that they are automatically locking shut when the doors close. Licensee to fix the doors by POC due date of 10/30/2026. Licensee is to inform LPA Frank when the doors are fixed. LPA will conduct a POC visit to confirm the front doors are
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Based on observation, interview and express admission the licensee did not comply with the section cited above in that the facility front doors are not automatically locking shut when the doors close which poses a potential health, safety or personal rights risk to persons in care.
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automatically locking when the doors close so that the deficiency may be cleared.
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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.
SUPERVISOR'S NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Robert Frank
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3