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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 317005468
Report Date: 03/01/2023
Date Signed: 03/03/2023 08:11:03 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/15/2022 and conducted by Evaluator Todd Tryon
PUBLIC
COMPLAINT CONTROL NUMBER: 25-AS-20220815124721
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: DATE:
03/01/2023
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:TIME COMPLETED:
04:30 PM
ALLEGATION(S):
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9
Facility is not stopping the spread of COVID-19

Staff did not routinely change resident's clothes
INVESTIGATION FINDINGS:
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On 3/1/2023 LPA Tryon visited the faciity to continue to work on the complaint. LPA self-screened for COVID symptoms prior to the visit. LPA met with Malissa Acuna, Executive Director.
LPA has spoken with staff and witnesses, toured the facility and reviewed documentation.
Regarding the allegation that the facility is not stopping the spread of COVID-19, LPA has spoken with staff and reviewed documentation. LPA learned that at the time of the allegation, the facility was routinely screening all visitors, staff and residents entering the facility. Temperatures were taken at the front door and visitors were screened.with questions regarding COVID symptoms. Staff and visitors were routinely wearing masks in the building. When there was a suspicion of a possible infection, isolation protocol was intiated, staff and residents were given tests thoughout the episode until clear. LPA also learned that resident R1 had moved into the facility from a hospital. R1 had only moved into the facility from the hospital when coming down with COVID. Because of this, it is not possible to say whether COVID may have been contracted in the facility, in the hospital, or somewhere else; or how it was spread. Therefore, LPA cannot say whether COVID was actually contracted at the facility; or that any action of the staff did or did not contribute to R1 becoming positive. Therefore, the allegation is Unsubstantiated.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 03/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023
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 25-AS-20220815124721
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
FACILITY NAME: BROOKDALE AUBURN
FACILITY NUMBER: 317005468
VISIT DATE: 03/01/2023
NARRATIVE
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Regarding the allegation that Staff did not change resident's clothes, LPA spoke with staff, witnesses and reviewed documentation.
LPA learned that resident R1 did apparently wear the same clothes for several days in a row at the facility. Staff said that they would offer R1 assistance to dress, and she would refuse or go back to the dirty laundry in the resident's room and switch clothes, putting on outfits previously warn. It appears that after a few days staff became aware that this was happening, and came up with a plan to remove the dirty clothes from the room, thus removing the possibility to change back to dirty clothes. R1 was new to the facility, and staff were not fully aware of her habits/behaviors at first. So, even though it does appear that R1 wore the same clothes for multiple days in a row, when staff became aware of the issue, it was dealt with appropriately. It does appear that assistance with dressing was included in the care plan, but LPA cannot say how much staff was aware of what assistance was really necessary for the first few days until they came to know R1. Allegation is unsubstantiated.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 03/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023
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
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/15/2022 and conducted by Evaluator Todd Tryon
PUBLIC
COMPLAINT CONTROL NUMBER: 25-AS-20220815124721

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: DATE:
03/01/2023
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:TIME COMPLETED:
04:30 PM
ALLEGATION(S):
1
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3
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9
Staff did not order resident's medication as required
Staff did not dispense prescribed medication to resident
Staff did not provide responsible party with a refund


INVESTIGATION FINDINGS:
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Regarding the allegation that staff did not provide responsible party with a refund, LPA has spoken with staff and witnesses and reviewed documenation.
From a letter dated 11/2/2022 LPA learned tha tthe facility did offer a refund of $2000 of the $2500 "Community Fee" paid by resident R1 upon admission; plus $895.35 as a "customer service credit,"
As per Brookdale Admission Agreement Section IV B signed 7/26/2022, Termination by Resident, You may terminate this Agreement, upon thirty (30) days written notice to us. Termination occurs on the later of the end of the notice period or upon the removal of all of your personal belongings.
Since R1 did not give a 30-day written notice, the facility is not required to issue a refund of the rent paid for that 30-day period.
Allegation is Unfounded.
Regarding the allegation that staff did not order resident's medication as required, LPA interviewed staff and reviewed documents. LPA learned that medication was requested from R1's doctor and a prescription was written. However, when the pharmacy received the prescription is was determined that it did not include
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 03/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023
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 25-AS-20220815124721
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
FACILITY NAME: BROOKDALE AUBURN
FACILITY NUMBER: 317005468
VISIT DATE: 03/01/2023
NARRATIVE
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required information. The facility attempted to bring this issue to the attention of the doctor's office, but the doctor was not available, and it took several days for the prescription to be written properly. It appears that the facility did make attempts to correct the situation and obtain the medications for R1, but was not able to get the mistake corrected immediately. This appear to have been an issue between the doctor's office and pharmacy that the facility did not have control over. It appears that facility staff did attempt to make R1's responsible party aware of the situation. So although it is true that the medication did not get filled as needed, the facility DID attempt to have it filled. Therefore, the allegation is unfounded.

Regarding the allegation that Staff did not dispense prescribed medication to resident, as noted above, the facility attempted to have the medication filled, but due to an issue between the doctor's office and the pharmacy, it took a few days to obtain the medication. As noted above the facility staff made attempts to correct the issue, but it took some time, leaving resident without medication. This does not appear to have been caused by a mistake or omission of the facility, therefore, the allegation is unfounded.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 03/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4