<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317005468
Report Date: 06/18/2024
Date Signed: 06/18/2024 02:00:39 PM


Document Has Been Signed on 06/18/2024 02:00 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



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: 76DATE:
06/18/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Malissa Acuna, EDTIME COMPLETED:
03:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On June 18, 2024 LPA Tryon visited the facility to conduct an annual inspection. LPA met with Executive Director Malissa Acuna. The facility currently has 76 residents.
LPA toured the facility with ED including common areas, dining rooms, kitchen, hallways, resident rooms, bathrooms, medication room, recreation areas, offices.
The facility is clean and in good condition. Rooms/apartments are nicely furnished and decorated. Maintenance appears to be ongoing as needed and facility is kept in good shape. LPA toured 7 resident apartments in Assisted Living, and 6 apartments in memory care. LPA was able to speak with 3 residents.
LPA viewed fire extinguishers that were all charged and up to date. Fire system/alarms/carbon monoxide detector system installed, checked regularly. Last inspection was 6/10/24 by the local Fire Marshall. System is checked quarterly.
LPA toured kitchen and food storage. Kitchen appeared to be clean, well-furnished with pots and pans, utensils, necessary tools and appliances, and a good supply of dishes. Food supplies appear to be varied and of good quality. Supply appears to meet the requirement of 2 days perishable and 7 days non-perishable supplies.
LPA reviewed 7 resident files and 7 staff files. Files appear to contain required documents and information.
Staff records include training in required areas. Staff records include fingerprint clearance and/or exemptions. Medications were viewed. Medications are kept organized in locked med carts, inside a locked medication room. Most medications are in bubble packs. Centrally stored medication logs are maintained.

Temperature in the building was comfortable. Residents appeared to be active and in good spirits overall.

At this time, the facility appears to be in substantial compliance with the regulations. No deficiencies were cited at this visit. Exit interview conducted.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/18/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1