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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347005467
Report Date: 08/07/2024
Date Signed: 08/07/2024 09:12:25 AM

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
05/06/2024 and conducted by Evaluator Kevin Mknelly
COMPLAINT CONTROL NUMBER: 59-AS-20240506111114
FACILITY NAME:BROOKDALE FOLSOMFACILITY NUMBER:
347005467
ADMINISTRATOR:KRISTINE CLAWSONFACILITY TYPE:
740
ADDRESS:780 HARRINGTON WAYTELEPHONE:
(916) 983-9300
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY:130CENSUS: 87DATE:
08/07/2024
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Dianne PalmerTIME COMPLETED:
09:20 AM
ALLEGATION(S):
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Staff member provides care under the influence of drugs and alcohol
INVESTIGATION FINDINGS:
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On 8/7/24, Licensing Program Analyst s (LPAs) Kevin Mknelly and Graham Gunby conducted an unannounced complaint investigation visit to deliver the findings for the above allegations and met with Dianne Palmer, Health and Wellness Director.

The department conducted records review and extensive interviews.
The department is unable to find and or meet the preponderance, per policy.

An anonymous report was received by the department on 5/6/24, with limited details alleging S1 has been under the influence of illegal drugs and alcohol while working at Brookdale – Folsom RCFE. Multiple attempts to identify and contact the reporting party were unsuccessful.

Current and former staff, as well as residents were interviewed and reported that S1 is a very good employee
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024
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-20240506111114
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: 08/07/2024
NARRATIVE
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and caregiver. There were no reports of any concern or suspicion that S1 had ever been under the influence of drugs or alcohol while working at the facility. There was no documented relevant disciplinary action or concerns in S1’s employee file.

S1 was interviewed and denied ever being under the influence of drugs or alcohol while working at the facility. Based on information obtained, there is not a preponderance of evidence to substantiate the allegation.

As a result of this investigation, LPA finds allegation to be (US)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 with Dianne Palmer and report copy provided.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2