015601324-4-20-2026-15-AS-BFOG-DU7QFL-20260518120805

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 015601324
Report Date: 04/20/2026
Date Signed: 04/20/2026 11:45:57 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/14/2026 and conducted by Evaluator Yasamin Brown

COMPLAINT CONTROL NUMBER: 15-AS-20260414120543

FACILITY NAME:	SUNRISE CARE HOME		FACILITY NUMBER:	015601324
ADMINISTRATOR:	TAYAG, NANCY		FACILITY TYPE:	740
ADDRESS:	1447 VIA LUCAS		TELEPHONE:	(510) 481-1300
CITY:	SAN LORENZO	STATE: CA	ZIP CODE:	94580
CAPACITY:	6	CENSUS: 5	DATE:	04/20/2026
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Nancy Tayag, Administrator		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff put up full bed rails on resident's bed without Physicians orders
Staff used bed rails as a restraint for resident

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 4/20/2026 at 9:30 AM, Licensing Program Analyst (LPA) Y. Brown arrived unannounced to conduct a complaint investigation and deliver findings in regards to the allegations above. LPA met with Nancy Tayag, Administrator and informed her the reason for visit.

During investigation, LPA obtained and reviewed the following documents: Resident Roster and the LIC500 (Personnel Report). LPA also collected and reviewed the following documents for Resident (R1): Hospice Care Plan, LIC602 (physician's report), Appraisal Needs and Services Plan, and Physicians Order. LPA conducted an interview with Staff (S1).

Continued on LIC9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Yasamin Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2026

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 2

Control Number 15-AS-20260414120543

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: SUNRISE CARE HOME	FACILITY NUMBER: 015601324
	VISIT DATE: 04/20/2026

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
26
27
28
29
30
31
32

Continued from LIC9099.

Allegation: Staff put up full bed rails on resident's bed without Physicians orders
Finding: Unsubstantiated

During record review and interview, LPA discovered that R1 was admitted to hospice care on 5/15/2025. LPA reviewed R1's hospice care plan dated 12/17/2025 on page 12 that it states, "Full bed rails with rail pads for safety" was ordered and approved for R1's care. LPA also reviewed two of R1's physicians order's. The first physicians order dated on 8/11/2025 orders "Full bed rails with rails pads for safety" and the second physicians order dated 4/13/2026 orders "Hospital bed with full rails with rails pads safety."

Allegation: Staff used bed rails as a restraint for resident
Finding: Unsubstantiated

LPA observed that R1 is able to adjust themselves but receives assistance to get into their wheel chair. LPA observed that the full bed rails have a an adjustment tool that allows the rails to go down when R1 wants to get out of bed.

Based on interviews and record review during visit, the allegations that Staff put up full bed rails on resident's bed without Physicians orders and Staff used bed rails as a restraint for resident was found to be unsubstantiated. A finding that a 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.

No deficiency cited.

Exit Interview conducted with Nancy and copy of this report provided.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Yasamin Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 2