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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 317005468
Report Date: 12/07/2022
Date Signed: 12/07/2022 12:17:14 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/09/2022 and conducted by Evaluator Todd Tryon
PUBLIC
COMPLAINT CONTROL NUMBER: 25-AS-20221109144603
FACILITY NAME:BROOKDALE AUBURNFACILITY NUMBER:
317005468
ADMINISTRATOR:MORGAN WHINERYFACILITY TYPE:
740
ADDRESS:11550 EDUCATION STTELEPHONE:
(530) 888-8847
CITY:AUBURNSTATE: CAZIP CODE:
95602
CAPACITY:110CENSUS: 70DATE:
12/07/2022
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Ronica Rao, Business Office CoordinatorTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Facility staff are not releasing past resident's records.
INVESTIGATION FINDINGS:
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On 12/7/2022 LPA Tryon visited the facility to finish this complaint. LPA was screened at the door for COVID symptoms. LPA met with Ronica Rao, Business Office Coordinator.
LPA has communicated with complainant and reviewed documentation. At this time, it appears that the facility has provided some documentation as per the request of the POA and representative of resident R1, but has not furnished several documents as spelled out on the request from POA and Representative. Documents that were requested but not provided were: LIC 602A Resident Appraisal; LIC 613C Personal Rights; LIC 621 Personal Property and Valuables; LIC 624 Unusual Incident Reports; LIC 622 Centrally Stored Medication Logs. Since these documents have still not been provided to POA/Representative as of this date, the allegation is SUBSTANTIATED. A finding of submstantiated means that the allegation is valid because the preponderance of the evidence standard has been met.
The following deficiency is cited as per Title 22, Section 87648.2 (a)(19). Appeal Rights provided, exit interview conducted..
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2022
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 2
Control Number 25-AS-20221109144603
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: BROOKDALE AUBURN
FACILITY NUMBER: 317005468
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/07/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/14/2022
Section Cited
CCR
87468.2(a)(19)
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In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: To have prompt access to review all of their records and to purchase photocopies of
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The facility will furnish resident records to POA/their representative as per rerquest. Records to be furnished, and proof of delivery forwarded to CCL by 12/14/2022..
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their records. Photocopied records shall be provided within two (2) business days and at a cost that does not exceed the community standard for photocopies. This is not met as evidenced by: Facility failed to provide requested records to POA/Representative. This causes a potential violation of resident rights.
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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: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2022
LIC9099 (FAS) - (06/04)
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