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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347005467
Report Date: 08/20/2026
Date Signed: 08/20/2026 01:31:25 PM

Substantiated


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
05/19/2026 and conducted by Evaluator Angela Hood
COMPLAINT CONTROL NUMBER: 59-AS-20260519152705
FACILITY NAME:BROOKDALE FOLSOMFACILITY NUMBER:
347005467
ADMINISTRATOR:SHARI KRANIGFACILITY TYPE:
740
ADDRESS:780 HARRINGTON WAYTELEPHONE:
(916) 983-9300
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY:130CENSUS: 76DATE:
08/20/2026
UNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Dianne Palmer, Health and Wellness DirectorTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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-Facility staff falsified resident's medical condition
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angela Hood arrived at the care home today and met with the Health and Wellness Director (HWD), Dianne Palmer, to deliver complaint investigation findings regarding the above stated allegation.

During the course of the investigation, LPA conducted interviews and obtained documentation pertinent to the investigation.

Resident (R1’s) Personal Service Plan, dated January 7, 2026 and signed by R1’s responsible party on January 8, 2026, indicated that care staff would be providing Chronic Condition Management. The chronic health condition selected on R1’s Personal Service Plan was Heart Failure, indicating that staff should be alert of swelling of the hands and feet, shortness of breath and activity intolerance, and sudden weight gain.
***********************************************Continued on LIC9099-C***************************************************
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Angela Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2026
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 8
Control Number 59-AS-20260519152705
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 FOLSOM
FACILITY NUMBER: 347005467
VISIT DATE: 08/20/2026
NARRATIVE
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Comments were added to the chronic health condition indicating hemiplegia and hemiparesis following unspecified cerebrovascular disease affecting left non-dominant side, dysarthria, and gastrointestinal hemorrhage. According to R1’s Medical Assessment LIC602A, dated January 7, 2026, R1 had the diagnoses of vascular dementia, hemiplegia and hemiparesis following unspecified cerebrovascular disease affecting left non-dominant side, dysarthria, gastrointestinal hemorrhage, gait abnormalities, heart murmur, edema, hx of stroke, hx of ischemic transient ischemic attacks, atherosclerosis of aorta, osteoporosis, atherosclerosis of aorta, along with multiple other health conditions. The facility’s Chronic Condition Management Infographic form indicated that dementia and stroke management are considered chronic health conditions. Although R1 required care staff management with their chronic health conditions, and they have diagnoses that may lead to heart failure, R1’s physician did not specify R1 had a diagnosis of heart failure. The facility did not correctly identify R1’s medical diagnosis as part of their personal services, which would affect the information provided to care staff on what symptoms they should be monitoring.

Based records reviewed, the preponderance of evidence standards have been met. Therefore, the above allegation is found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D page.

Exit interview conducted. A copy of this report and appeal rights were provided.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Angela Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 8
Control Number 59-AS-20260519152705
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 FOLSOM
FACILITY NUMBER: 347005467
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/20/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/03/2026
Section Cited
CCR
87207
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87207 False Claims: No licensee, officer or employee of a licensee shall make or disseminate any…misleading statement regarding the facility or any of the services provided by the facility.
This requirement is not met as evidenced by:
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Facility agrees to create a plan to ensure that they are correctly identifying residents’ medical diagnoses in their personal services and submit to LPA by the POC due date of 9/3/26.

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Based on records reviewed, the facility selected the incorrect medical diagnosis for (R1’s) personal services, which poses a potential health, safety, and personal rights risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Laura Munoz
LICENSING EVALUATOR NAME: Angela Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 8
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
05/19/2026 and conducted by Evaluator Angela Hood
COMPLAINT CONTROL NUMBER: 59-AS-20260519152705

FACILITY NAME:BROOKDALE FOLSOMFACILITY NUMBER:
347005467
ADMINISTRATOR:SHARI KRANIGFACILITY TYPE:
740
ADDRESS:780 HARRINGTON WAYTELEPHONE:
(916) 983-9300
CITY:FOLSOMSTATE:CAZIP CODE:
95630
CAPACITY:130CENSUS: 76DATE:
08/20/2026
UNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Dianne Palmer, Health and Wellness DirectorTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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-Staff are not providing medications as prescribed
-Staff do not provide adequate food service
-Staff do not provide resident assistance with ADLs
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angela Hood arrived at the care home today and met with the Health and Wellness Director (HWD), Dianne Palmer, to deliver complaint investigation findings regarding the above stated allegations.

During the course of the investigation, LPA conducted interviews, made observations, conducted a medication count, and obtained documentation pertinent to the investigation.

On August 19, 2026, LPA conducted a medication count for residents (R8, R9, and R10) as R1 no longer resided at the care home and medications were not available for medication count. LPA conducted a medication count comparing the residents' medication lists on file with the medication centrally stored for the residents. LPA did not observe any medication errors. Interview with staff (S5) indicated that, on May 15, 2026, R1 refused medications as they could not wake up. S5 indicated that R1’s responsible party attempted to provide medications; however, R1 spit them out. Interviews with residents (R2, R3, R4, and R5) indicated that they are receiving all of their medications on time.
**********************************************Continued on LIC9099-C*************************************************
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Angela Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 8
Control Number 59-AS-20260519152705
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 FOLSOM
FACILITY NUMBER: 347005467
VISIT DATE: 08/20/2026
NARRATIVE
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On May 15, 2026, resident (R1’s) progress notes time stamped 10:24am indicated that the HWD was notified by care staff and med tech that R1 was “in a deep sleep not able to wake up not easily aroused”. The progress notes also indicated that R1 was not able to take their medications due to not being easily aroused, in a deep sleep, and not responding to call or touch. R1 was still asleep and breathing. Fax correspondence dated May 14, 2026 to R1’s physician indicated that R1 was experiencing a significant change in their condition even after starting Keppra medication. R1 was not tolerating a mechanical soft diet with regular liquids well and continued to aspirate during meals. R1 was sleeping most of the day and frequently spitting out their medications. R1 was also no longer participating in any ADLs independently. The facility indicated that they were requesting advice regarding further recommendations for R1’s plan of care. Fax correspondence dated May 15, 2026 to R1’s physician indicated that staff notified the HWD that R1 did not take their morning medication as they were not easily aroused and in a deep sleep. R1 fully woke at around 10:30am and vitals were taken. The facility requested that the physician reassess R1 and change R1’s diet order as R1 was having difficulty swallowing with a mechanical soft diet and was aspirating. On May 15, 2026, R1’s physician responded to the facility indicating that, if R1 was having difficulties/worsening of swallowing, then they could place a referral to a speech therapist for a more formal swallow study; however, R1 either needed to be able to get to the appointment or needed to be seen by them in person so they could place a home health order. On May 18, 2026, a fax was sent to R1’s physician to send an order for supplemental shakes and to complete a physician diet order form as R1’s responsible party had been bringing R1 boost plus shakes. The facility did not have a physician’s order for the shakes.

On August 18, 2026, LPA conducted a tour of the kitchen area and observed the facility has the required (2) two-day perishable and (7) seven-day non-perishable food supply on hand. In the kitchen, there was a modified diet board on the wall indicating all residents who require a modified diet along with their names, photos, and room numbers. The board is also organized by type of modified diet. Interviews with staff (S1) indicated that the cooks ensure that the modified diets are followed. S1 indicated that the residents’ plate lids are labeled with the type of modified diet and color coded. LPA observed the labels being used. S1 indicated that food and snacks are all sent to memory care. LPA observed that, in memory care, there are snacks and drinks available such as apple sauce, Jello, yogurt, fruits, sugar free ice cream, soda, water dispenser, coffee, and juice. Interviews with R2, R3, R4, R5 and residents (R6 and R7) indicated that the food is good and they are getting plenty to eat. Interview with R2 indicated that they believe their modified diet is being followed by the care home. S2, S3, S4, and S5 indicated that R1’s diet was followed based on
**********************************************Continued on LIC9099-C***************************************************
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Angela Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 8
Control Number 59-AS-20260519152705
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 FOLSOM
FACILITY NUMBER: 347005467
VISIT DATE: 08/20/2026
NARRATIVE
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physician’s orders. LPA also received a copy of the facility’s weekly menu, the alternative menu for assisted living, and the August snack menu for memory care. Each menu provides a variety of food options for residents in care.

Interviews with S2, S3, S4, and S5 indicated that care staff always ensured R1 was receiving assistance with their activities of daily living (ADLs). S2, S3, S4, and S5 indicated that R1 was never left soiled or wet. Interviews indicated that R1 was never left in bed or their wheelchair for an extended period of time. Interviews with staff also indicated that they do not keep a log of when they provide assistance with ADLs. Interviews with R2, R3, R4, R5, R6, and R7 indicated that all of their care needs are being met. R3, R6, and R7 indicated that they are never left wet or soiled. R4 and R6 indicated that they are being checked on by care staff frequently throughout the day. R2, R3, R4, R5, R6, and R7 indicated that they have no concerns regarding the care being provided at the facility.

Based on interviews conducted, observations made, and documentation obtained, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Therefore, the allegations are UNSUBSTANTIATED. No deficiencies are being cited. Exit interview conducted. A copy of the report was provided.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Angela Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2026
LIC9099 (FAS) - (06/04)
Page: 6 of 8
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
05/19/2026 and conducted by Evaluator Angela Hood
COMPLAINT CONTROL NUMBER: 59-AS-20260519152705

FACILITY NAME:BROOKDALE FOLSOMFACILITY NUMBER:
347005467
ADMINISTRATOR:SHARI KRANIGFACILITY TYPE:
740
ADDRESS:780 HARRINGTON WAYTELEPHONE:
(916) 983-9300
CITY:FOLSOMSTATE:CAZIP CODE:
95630
CAPACITY:130CENSUS: 76DATE:
08/20/2026
UNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Dianne Palmer, Health and Wellness DirectorTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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-Staff do not provide resident's responsible party with copies of resident's records
-Resident is being charged for services not provided
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angela Hood arrived at the care home today and met with the Health and Wellness Director (HWD), Dianne Palmer, to deliver complaint investigation findings regarding the above stated allegations.

During the course of the investigation, LPA obtained documentation pertinent to the investigation.

Email correspondence between the Executive Director (ED) and resident (R1’s) responsible party indicated that documentation was requested by R1’s responsible party on April 29, 2026. On May 13, 2026, the ED indicated that they submitted a request to release records and were awaiting a response. On May 14, 2026, R1’s responsible party responded to the ED’s email indicating that they authorize R1’s records to be released to two specific family members when the records are ready to pick up. On May 20, 2026, one of the specified family members signed that they are in receipt of the requested records for R1 on a form provided by the facility.
*********************************************Continued on LIC9099-C*****************************************************
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Angela Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 7 of 8
Control Number 59-AS-20260519152705
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 FOLSOM
FACILITY NUMBER: 347005467
VISIT DATE: 08/20/2026
NARRATIVE
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According to the facility’s Price Schedule, the facility charges $175 for specific care and/or monitoring due to chronic conditions with some examples listed as edema and activity intolerance. The facility’s Chronic Condition Management Infographic form indicated that dementia and stroke management are considered chronic health conditions. R1’s Medical Assessment LIC602A, dated January 7, 2026, indicated that R1 had the diagnoses of vascular dementia, hemiplegia and hemiparesis following unspecified cerebrovascular disease affecting left non-dominant side, dysarthria, gastrointestinal hemorrhage, gait abnormalities, heart murmur, edema, hx of stroke, hx of ischemic transient ischemic attacks, atherosclerosis of aorta, osteoporosis, atherosclerosis of aorta, along with multiple other health conditions. R1’s Assessment Summary indicated that they were being charged for medication management, chronic condition management, nutrition, dressing and grooming, showering and bathing, bathroom assistance, and two person transfer or mechanical lift. According to R1’s Account History Report, they were charged the correct dollar amount for all personal services each month.

According to R1’s Admission Record, their admission date was January 8, 2026. Email correspondence dated May 27, 2026 from R1’s responsible party to the ED and Health and Wellness Director (HWD) indicated that R1’s responsible party was emailing as a formal 30-day notice that R1 would be transferring from the facility on June 4, 2026. R1’s Progress Notes indicated that R1 moved out of the care home on June 4, 2026. R1’s Account History Report indicated that they were charged a prorated amount for care and rent the month of June as they moved out of the care home on June 4, 2026.

Based on documentation obtained, the above allegations are found to be UNFOUNDED. A finding that the allegations are unfounded means that the allegations are false, could not have happened, and/or are without a reasonable basis. No deficiencies are being cited.
Exit interview conducted. A copy of the report was provided.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Angela Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2026
LIC9099 (FAS) - (06/04)
Page: 8 of 8