347005467-7-28-2022-25-AS-TORZ-CH5NBL-20220809101919

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347005467
Report Date: 07/28/2022
Date Signed: 07/28/2022 03:32:02 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/24/2022 and conducted by Evaluator Lavinia Muscan

COMPLAINT CONTROL NUMBER: 25-AS-20220524084048

FACILITY NAME:	BROOKDALE FOLSOM		FACILITY NUMBER:	347005467
ADMINISTRATOR:	KRISTINE CLAWSON		FACILITY TYPE:	740
ADDRESS:	780 HARRINGTON WAY		TELEPHONE:	(916) 983-9300
CITY:	FOLSOM	STATE: CA	ZIP CODE:	95630
CAPACITY:	130	CENSUS: 105	DATE:	07/28/2022
		UNANNOUNCED	TIME BEGAN:	10:18 AM
MET WITH:	Kristine Clawson		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff dispensing Medications don't have proper Medication Training
Control Drug counts are not accurate
Medication are found on floor, trash can, wheelchair and bed
Staff did not distribute resident's self administered medications as prescribed

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Lavinia Muscan and Licensing Program Manager (LPM), Laura Munoz , arrived at the facility unannounced on 07/28/2022 to deliver complaint findings for the allegation(s) listed above. LPA and LPM conducted COVID-19 Precautionary pre screening, and wore surgical masks while at facility. LPA and LPM were screened by Front Desk.

ALLEGATION: Staff dispensing Medications don't have proper Medication Training
During the complaint investigation, LPA reviewed training records for all staff, including Med Tech's. In addition interviews were conducted. Training records for Med Tech's show staff have met sufficient training hours in shadowing and in-class training. This agency has investigated the complaint alleging "Staff dispensing medications do not have proper training". We have found the complaint was UNFOUNDED, meaning that the allegation is false, could not have happened, and/or is without a reasonable basis.

Continued on LIC9099-C

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Lavinia Muscan	TELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 25-AS-20220524084048

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: BROOKDALE FOLSOM	FACILITY NUMBER: 347005467
	VISIT DATE: 07/28/2022

NARRATIVE

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ALLEGATION: Control Drug counts are not accurate
During the complaint investigation, a review of medication documentation was conducted for 10 residents. Control medication records for all 10 residents proved to be accurate. We have found the complaint was UNFOUNDED, meaning that the allegation is false, could not have happened, and/or is without a reasonable basis.

ALLEGATION: Medication are found on floor, trash can, wheelchair and bed
During the complaint investigation, LPA interviewed staff and conducted a walk thru of the facility. During the walk thru no medications were observed to be on the floor or any other area other than the medication room. Interviews indicated medications have not been found on any floor area in the facility but the medication room, which is inaccessible to residents. This agency has investigated the complaint alleging "Medications are found on the floor, trash can, wheelchair and bed". We have found the complaint was UNFOUNDED, meaning that the allegation is false, could not have happened, and/or is without a reasonable basis.

ALLEGATION: Staff did not distribute resident's self administered medications as prescribed
During the complaint investigation, a review of medication documentation was conducted for 6 residents After reviewing 6 resident MARS, there was no indication that medications were not distributed as prescribed. This agency has investigated the complaint alleging "Staff did not distribute resident's self administered medications as prescribed". We have found the complaint was UNFOUNDED, meaning that the allegation is false, could not have happened, and/or is without a reasonable basis.

Based on this investigation, no deficiencies are cited.

Exit interview and copy of report provided.

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Lavinia Muscan	TELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2022

LIC9099 (FAS) - (06/04)

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