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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003712
Report Date: 10/27/2022
Date Signed: 10/27/2022 10:57:39 AM


Document Has Been Signed on 10/27/2022 10:57 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:BROOKDALE SYLVAN RANCHFACILITY NUMBER:
347003712
ADMINISTRATOR:KAYLA YOUNGFACILITY TYPE:
740
ADDRESS:7375 STOCK RANCH RDTELEPHONE:
(916) 729-2722
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY:56CENSUS: 37DATE:
10/27/2022
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jerilyn Purol- Executive Director TIME COMPLETED:
11:10 AM
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On 10/27/2022 at 9:00 AM, Licensing Program Analyst (LPA) Sarena Keosavang, CDPH HAI Cherish Mendoza, and Sacramento County Public Health Registered Nurse Rania Alnubani arrived at the facility unannounced to conduct a Case Management COVID-19 infection control inspection. LPA met with Wellness Director, Ayana Allison, and explained the purpose of the visit. Wellness Director confirmed positive COVID-19 cases at the facility.

At 9:30 AM, LPA Keosavang toured the interior of the facility with Executive Director, Jerilyn Purol, to ensure COVID-19 infection control policy is implemented. LPA observed COVID-19 signages posted at the entrance to remind staff and visitors to wear a mask before entering the facility. LPA observed front desk screening visitors by taking temperatures and asking visitors to fill out questionnaire.

ED stated PPE supplies and staffing is adequate.

Recommendations from LPA, CDPH HAI, and Sacramento County Public Health:
  • Fit testing for N-95 respirators.
  • Taking COVID positive residents vital signs every 4 hours.
  • Staff training on infection control.
  • Hand sanitizers/ hand hygiene.
  • Cleaning supplies calibration.
  • Food services/ deliveries.


No deficiencies are cited during today's visit.

Exit interview conducted.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Sarena KeosavangTELEPHONE: (209) 202-9552
LICENSING EVALUATOR SIGNATURE:
DATE: 10/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/27/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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