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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347003712
Report Date: 12/19/2023
Date Signed: 12/19/2023 04:01:38 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, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/15/2023 and conducted by Evaluator Cheyenne Ratajczak
COMPLAINT CONTROL NUMBER: 59-AS-20231215155333
FACILITY NAME:BROOKDALE SYLVAN RANCHFACILITY NUMBER:
347003712
ADMINISTRATOR:JERILYN PUROLFACILITY TYPE:
740
ADDRESS:7375 STOCK RANCH RDTELEPHONE:
(916) 729-2722
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY:56CENSUS: 32DATE:
12/19/2023
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Jerilyn PurolTIME COMPLETED:
04:15 PM
ALLEGATION(S):
1
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5
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7
8
9
Staff force resident to eat while in care.
INVESTIGATION FINDINGS:
1
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On 12/19/23 Licensing Program Analysts (LPAs) Cheyenn Ratajczak and Cassie Yang arrived at the facility unnanounced to open the complaint and deliver the findings. LPAs met with Executive Director (ED) Jerilyn Purol and explained the purpose of the visit.

During this investigation LPAs interviewed ED, four (4) staff and seven (7) residents.

The result of the investigation is as followed please see LIC9099C
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Cheyenne RatajczakTELEPHONE: (916) 969-7879
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023
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 2
Control Number 59-AS-20231215155333
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: BROOKDALE SYLVAN RANCH
FACILITY NUMBER: 347003712
VISIT DATE: 12/19/2023
NARRATIVE
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Allegation:Staff force resident to eat while in care.
Based on interview conducted with ED, it revealed that all residents are self fed. ED stated residents who need assistance with feedings are fed privately in their rooms with caregiver. Interview further revealed that all residents in care are English speakers.

Interview conducted with S1 revealed that only R1 requires assistance with feeding. Interview further revealed that the resident is non verbal and may be aggressive at times. Interviews conducted with S2, S3, S4 revealed that R1 is non-verbal but is able to communicate when they want more food. Interviews further revealed R1 does not reject food and is a good eater.

Based on interviews conduct with R2 and R3 revealed that staff does not force feed during meal times. R2 and R3 stated that they can feed themselves. Interviews conducted with R4 and R5 revealed that they have never witnessed residents in care being force fed. Interviews conducted with R7 revealed staff do not aggressively feed residents but ensure residents are provided the materials needed for feeding.


Based on the extensive interviews conducted, LPAs find the allegation to be UNFOUNDED-means that the allegation is false, could not have happened, and/or is without a reasonable basis.

Exit interview conducted. Copy of report and appeal rights was provided to Administrator.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Cheyenne RatajczakTELEPHONE: (916) 969-7879
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023
LIC9099 (FAS) - (06/04)
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