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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003712
Report Date: 07/02/2021
Date Signed: 07/02/2021 03:18:09 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:BROOKDALE CITRUS HEIGHTSFACILITY NUMBER:
347003712
ADMINISTRATOR:ALEJANDRA C SALLEEFACILITY TYPE:
740
ADDRESS:7375 STOCK RANCH RDTELEPHONE:
(916) 729-2722
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY:56CENSUS: 19DATE:
07/02/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Christine SalleeTIME 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 7/2/2021 LPA Todd Tryon arrived at the facility to do a case management visit. The purpose of the visit was to follow up on an Incident Report dated 5/14/2021.
Prior to initiating the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms and contacted the facility and completed a facility risk assessment. LPA ensured he applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. Additionally, LPA was screened by facility staff upon entering the facility.

LPA spoke with Executive Director Christine Sallee. We discussed an incident report dated 5/14/2021 regarding resident R1. The report stated that on 5/14/21 at about 2:10 p.m. the facility received a call from a nearby auto parts store. They said that they had resident R1 there at the store. Staff then went to the store and brought R1 home. R1 stated he went out to buy a phone. It was found that he had gone out through the gate from the back yard of the building. R1 was fine when he got back. He was monitored for 72 hours and suffered no effects from his incident.

After the incident, staff have received training regarding elopement, and are doing regular "elopement drills." Also, the back gate alarm is routed to go through staff pagers; and regular gate checks were initiated.

At this time, it appears that the facility reacted appropriately to the situation upon discovery, did training with staff, is continuing to do ongoing training; the alarm is routed through pagers.

No deficieny has been cited at this visit.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 208-7709
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2021
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