347003712-2-19-2025-59-AS-LMUZ-DE4NVK-20250221094803

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347003712
Report Date: 02/19/2025
Date Signed: 02/19/2025 12:15:07 PM

Unsubstantiated

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
05/16/2024 and conducted by Evaluator Cheyenne Ratajczak

COMPLAINT CONTROL NUMBER: 59-AS-20240516125100

FACILITY NAME:	BROOKDALE SYLVAN RANCH		FACILITY NUMBER:	347003712
ADMINISTRATOR:	JERILYN PUROL		FACILITY TYPE:	740
ADDRESS:	7375 STOCK RANCH RD		TELEPHONE:	(916) 729-2722
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95621
CAPACITY:	56	CENSUS: 35	DATE:	02/19/2025
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Jerilyn Purol		TIME COMPLETED:	12:20 PM

ALLEGATION(S):

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Staff does not administer residents medication as prescribed
Lack of care and supervision resulting in residents sustaining multiple falls
Facility is not following food preparation safety procedures
Staff serve expired and spoiled food to residents in care

INVESTIGATION FINDINGS:

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On 02/19/2025, Licensing Program Analyst (LPA) Cheyenne Ratajczak and Licesnsing Program Manager (LPA) Laura Munoz arrived at the facility unannounced to deliver final findings for a complaint Community Care Licensing (CCL) received on 05/16/2024. LPA and LPM met with Executive Director (ED) Jerilyn Purol and explained the purpose of the visit.

During the course of the investigation, the Department conducted interviews and obtained pertinent documents relevant to the complaint investigation.

Please continue to LIC09099...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Cheyenne Ratajczak	TELEPHONE: (916) 969-7879
LICENSING EVALUATOR SIGNATURE:	DATE: 02/19/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025

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 5

Control Number 59-AS-20240516125100

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: 02/19/2025

NARRATIVE

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Allegation: Staff does not administer residents medication as prescribed
On 02/19/2025 LPA and LPM conducted a medication audit for three (3) residents. Resident #1 (R1) did have a discontinued medication with their currents meds but it has not been given to the resident since it was discontinued. Additionally, R1 was out of a medication but the facility is waiting for the refill.Based upon the information obtained during investigation, the above allegation is unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.
Allegation: Lack of care and supervision resulting in residents sustaining multiple falls
During the course of the investigation LPAs interviewed facility staff. Interviews with staff revealed that the facility does have a handful of residents who are a fall risk. All staff are aware of which residents are a fall risk as well as their care needs. LPA reviewed all Unusual Incidents Reports (UIRs) regarding falls from May 2024 to September 2024. LPA found no discrepancies with falls and that the facility documented the falls as required with follow ups as necessary. Additionally, LPA reviewed the Post Fall Evaluation for six (6) residents. Based upon the information obtained during investigation, the above allegation is unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.
Allegation: Facility is not following food preparation safety procedures
On 05/22/2024 LPA Ratajczak and LPA Hiratsuka conducted staff interviews which indicated staff are trained on proper food preparation procedures. On 02/19/2025 LPA and LPM conducted a tour of the facility kitchen. Based upon the information obtained during investigation, the above allegation is unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.
Allegation: Staff serve expired and spoiled food to residents in care
On 05/22/2024 LPA Ratajczak and LPA Hiratsuka conducted staff interviews. Staff interviews indicated they have not observed any expired or spoiled food. Additionally, 02/19/2025 LPA and LPM conducted a tour of the facility kitchen, which included looking at facilities perishable and non- perishable foods. LPA and LPM did not observed any spoiled or expired food. Based upon the information obtained during investigation, the above allegation is unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.
Exit interview conducted and a copy of the report and appeal rights was left at the facility.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Cheyenne Ratajczak	TELEPHONE: (916) 969-7879
LICENSING EVALUATOR SIGNATURE:	DATE: 02/19/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 5

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
05/16/2024 and conducted by Evaluator Cheyenne Ratajczak

COMPLAINT CONTROL NUMBER: 59-AS-20240516125100

FACILITY NAME:	BROOKDALE SYLVAN RANCH		FACILITY NUMBER:	347003712
ADMINISTRATOR:	JERILYN PUROL		FACILITY TYPE:	740
ADDRESS:	7375 STOCK RANCH RD		TELEPHONE:	(916) 729-2722
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95621
CAPACITY:	56	CENSUS: 35	DATE:	02/19/2025
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Jerilyn Purol		TIME COMPLETED:	12:20 PM

ALLEGATION(S):

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Staff handled resident in a rough manner.
Lack of care and supervision resulting in resident's sustaining pressure injuries.
Facility is not providing incontinence care products.
Facility is not addressing the pests issue.

INVESTIGATION FINDINGS:

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Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Cheyenne Ratajczak	TELEPHONE: (916) 969-7879
LICENSING EVALUATOR SIGNATURE:	DATE: 02/19/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025

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 5

Control Number 59-AS-20240516125100

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: 02/19/2025

NARRATIVE

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Allegation: Staff handled resident in a rough manner.- Unfounded

On 05/02/24 LPA Ratajczak conducted a case management visit to gather additional information regarding an unusual incident/injury report that was sent to Community Care Licensing (CCL) on 04/25/2024. That report indicated that Staff #1 (S1) allegedly used force to redirect a resident from another resident’s room. LPA interviewed the Executive Director (ED), Jerilyn Purol and S1. This resident was no longer walking and would crawl to get around the facility. On this particular day, S1 was redirecting R1 out of another resident’s bedroom. S1 and R1 were holding hands as R1 was crawling out of the bedroom. Interviews indicated it could have been perceived as if R1 was being dragged however because R1 ambulated by crawling, R1 would request that staff hold their hand for assistance. Based on information obtained through interviews and file review the Department finds the allegation to be UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

Allegation: Lack of care and supervision resulting in resident's sustaining pressure injuries. - Unfounded

LPA conducted a record review for R2 who had documented pressure injuries. R2’s resident file indicated that although R2 had pressure injuries, R2 was receiving Hospice services. Wounds were being monitored and cared for my Hospice staff. Based on information obtained through file review the Department finds the allegation to be UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

Allegation: Facility is not providing incontinence care products. - Unfounded

Interview with ED, Jerilyn Purol, revealed that the facility does not provide incontinence care products for residents. The facility does have a program called Personal Solutions. Residents can sign up for an auto-ship program where their personal products, including incontinence supplies, are shipped directly to the facility. Many families provide the residents with their incontinence care products and have them shipped to the facility from Amazon. Residents who are on hospice are provided with incontinence care products from the hospice agency. Based on information obtained through interviews, the Department finds the allegation to be UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Cheyenne Ratajczak	TELEPHONE: (916) 969-7879
LICENSING EVALUATOR SIGNATURE:	DATE: 02/19/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 59-AS-20240516125100

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: 02/19/2025

NARRATIVE

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Allegation: Facility is not addressing the pests issue. - Unfounded

Interviews with staff revealed that they have seen cockroaches in the facility on occasion. During LPAs visit no pests were observed. Interview with ED, erilyn Purol revealed that the facility has Ecolab come out monthly. Facility keeps a binder with documentation of each of their visits. Some of the things that Ecolab has sprayed for are cockroaches, ants, files, silkworms and more. Based on information obtained through interviews and file review the Department finds the allegation to be UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

Exit interview conducted and a copy of the report and appeal rights was left at the facility.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Cheyenne Ratajczak	TELEPHONE: (916) 969-7879
LICENSING EVALUATOR SIGNATURE:	DATE: 02/19/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025

LIC9099 (FAS) - (06/04)

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