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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 317005468
Report Date: 10/11/2023
Date Signed: 10/11/2023 03:18:52 PM

Unfounded


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
08/21/2023 and conducted by Evaluator Bethany Mirlohi
COMPLAINT CONTROL NUMBER: 59-AS-20230821112726
FACILITY NAME:BROOKDALE AUBURNFACILITY NUMBER:
317005468
ADMINISTRATOR:MALISSA ACUNAFACILITY TYPE:
740
ADDRESS:11550 EDUCATION STTELEPHONE:
(530) 888-8847
CITY:AUBURNSTATE: CAZIP CODE:
95602
CAPACITY:110CENSUS: 73DATE:
10/11/2023
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Malissa Acuna, Administrator TIME COMPLETED:
03:40 PM
ALLEGATION(S):
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Staff allow the residents to be soiled for an extended periods of time
Insufficient staffing to provide adequate care and supervision
Staff do not practice safe food handling techniques
Staff do not properly maintain the facility grounds
Staff do not provide hygiene products
Staff are chemically restraining the residents while in care
Staff are mishandling the residents medications
Staff are yelling at the residents while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to deliver complaint findings. LPA met with Administrator Malissa Acuna during today’s inspection.
LPA investigation allegation, “Insufficient staffing to provide adequate care and supervision”. LPA interviewed 5 residents that required care and supervision. 5 of 5 residents stated there are sufficient staff to meet their needs. 2 of 5 residents stated they have had to wait over 30 minutes for care at times. LPA interviewed 4 care staff at the facility, of which all stated there is sufficient staffing unless they have call offs. Care staff stated they are able to meet the residents’ care needs. Due to the information gathered LPA finds the allegation to be UNFOUNDED.

Continuation on 9099-C.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany MirlohiTELEPHONE: (916) 204-8288
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023
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 59-AS-20230821112726
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: 10/11/2023
NARRATIVE
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LPA investigated allegation, “Staff allow the residents to be soiled for an extended periods of time”. LPA interviewed 5 residents in care in which they stated their care needs are being met. LPA interviewed 4 care staff in which they stated they have not observed residents soiled and left in an extended period of time. Care staff stated they have heard about times that has occurred, but they did not observe it. LPA interviewed administrator in which she stated she is not aware of residents being left soiled for an extended period of time. Due to the information gathered, LPA finds allegation to be UNFOUNDED.
LPA investigated the allegation, “Staff do not practice safe food handling techniques”. LPA toured the facility kitchen, refrigerator, freezer, dry storage, and food preparation area. LPA observed 2-day perishable and 7-day nonperishable amount of food. LPA observed all food to be properly stored and all food appeared to be fresh and within the expiration date limits. Kitchen appeared to clean, sanitary, and free from smell. Due to the information gathered, LPA finds allegation to be UNFOUNDED.
LPA investigated the allegation, “Staff do not properly maintain the facility grounds”. LPA interviewed 5 residents in which they stated the facility, and their room is kept clean at all times. 1 resident stated staff forget to empty their trash within their room on the weekends. LPA interviewed the administrator, in which she stated there is a housekeeper at the facility 7 days a week. Common spaces get cleaned daily, resident rooms get cleaned weekly, and sections of the facility get deep cleaned throughout the week. LPA interviewed 1 housekeeper in which she stated they clean the facility 7 days a week. LPA toured the facility and inspected common living spaces, resident rooms assisted living and memory care units, kitchen, and memory care unit. LPA observed the facility to be clean and sanitary with no smell present. Due to the information gathered, LPA finds the allegations to be UNFOUNDED.

Continuation on 9099-C.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany MirlohiTELEPHONE: (916) 204-8288
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 59-AS-20230821112726
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: 10/11/2023
NARRATIVE
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LPA investigated allegation, “Staff do not provide hygiene products.” LPA interviewed 1 housekeeper in which they stated the facility provides the residents with basic hygiene items like toilet paper. LPA interviewed 5 resident in which they stated the facility provides them with basic hygiene products if needed. LPA interviewed administrator in which she stated there is a storage room full of basic hygiene items for residents if needed. LPA toured the storage room on the 2nd and 3rd floor which had toilet paper, soap, caregiver supplies, continence supplies, and other hygiene items. Due to the information gathered, LPA finds allegation to be UNFOUNDED.
LPA investigated allegation, “Staff are chemically restraining the residents while in care.” LPA reviewed 4 resident medications, reviewing the present medications with resident MARS and physician orders. LPA interviewed 4 residents which required medication management from the facility staff. 4 of 4 residents stated they receive their medication daily and have had no problems with the medication management. LPA interviewed administrator in which she stated the medication technicians follow physician orders and give medications as prescribed. LPA interviewed 1 medication technician in which they stated if a hospice resident has a PRN medication order they call hospice before giving a PRN medication. Medication technician stated they follow medication orders which are on the resident MARS. Due to the information gathered LPA finds the allegation to be UNFOUNDED.
LPA investigated, "Staff are mishandling the residents medications". LPA reviewed 4 resident medications, reviewing the present medications with resident MARS and physician orders. LPA interviewed 4 residents which required medication management from the facility staff. 4 of 4 residents stated they receive their medication daily and have had no problems with the medication management. LPA interviewed administrator in which she stated the medication technicians follow physician orders and give medications as prescribed. LPA interviewed 1 medication technician in which they stated they follow medication orders which are on the resident MARS. Due to the information gathered LPA finds the allegation to be UNFOUNDED.

Continuation 9099-C.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany MirlohiTELEPHONE: (916) 204-8288
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 59-AS-20230821112726
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: 10/11/2023
NARRATIVE
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LPA investigated allegation, “Staff are yelling at the residents while in care.” LPA interviewed 5 residents in which they stated they have not been yelled at or observed any other resident being yelled at by facility staff. LPA interviewed 4 care staff in which they stated they have not observed any staff yelling at residents in care. LPA interviewed administrator in which she stated she has not observed any staff yelling at a resident in care. Due to the information gathered LPA finds allegation to be UNFOUNDED.

Exit interview conducted and copy of report provided.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany MirlohiTELEPHONE: (916) 204-8288
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4