019200755-2-16-2023-15-AS-KHOS-CR7KAR-20230424074422

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200755
Report Date: 02/16/2023
Date Signed: 02/16/2023 04:18:32 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
08/09/2021 and conducted by Evaluator Alicia Delmundo

COMPLAINT CONTROL NUMBER: 15-AS-20210809150809

FACILITY NAME:	SUNRISE ASSISTED LIVING OF OAKLAND HILLS		FACILITY NUMBER:	019200755
ADMINISTRATOR:	NEVAREZ, KARINA		FACILITY TYPE:	740
ADDRESS:	11889 SKYLINE BLVD		TELEPHONE:	(510) 531-7190
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94619
CAPACITY:	100	CENSUS: 74	DATE:	02/16/2023
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Dillon Cagulada/Executive Director		TIME COMPLETED:	04:10 PM

ALLEGATION(S):

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Facility staff did not ensure that residents were fed.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Delmundo arrived unannounced to continue the investigation of the above allegation and close the complaint. LPA met with Executive Director Dillon Cagulada, and informed the purpose of visit.

It was alleged that staff did not ensure that residents were fed. It was further alleged that family member has to go to the dining, and demand for residents food, and that at times. residents were given the wrong order.

During the course of investigation, LPA obtained copies of resident roster, staff schedule and menus, reviewed residents' records, and obtained copies of Admission Agreement, LIC602A Physician's Report and Care Plan. LPA interviewed Executive Director Dillon Gagulada, former Executive Director Karina Nevarez, residents (R1, R2. R3 and R4) and staff (S1, S2, S3, S4, S5, S6 and S7) on 8/18/21, 2/07/23. 2/11/23 and 2/16/23. LPA inspected the kitchen.
..........continued on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Alicia Delmundo	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023

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 15-AS-20210809150809

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: SUNRISE ASSISTED LIVING OF OAKLAND HILLS	FACILITY NUMBER: 019200755
	VISIT DATE: 02/16/2023

NARRATIVE

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Executive Director stated that Sunrise has corporate dietician who is working with the dining services coordinator and conducting training.

LPA observed the kitchen has list of residents on mechanical soft, pureed diet and residents who have food allergies. Review of menu for the day was consistent with what will be prepared by the kitchen staff.

Family member indicated dinner starts at 5pm and the kitchen closes at 7pm everyday. If the wrong food is delivered just before the kitchen closes, that resident will not get the correct food, because the kitchen closes too soon.

One (1) out of 4 residents interviewed stated that sometimes this resident ordered food, and given different one. The other 3 residents stated they get what they ordered. All 4 stated they were provided their meal. One of the 4 residents stated staff take the meal order ahead of time which LPA observed on 8/18/21.

All staff interviewed stated they never receive any complaint about residents not provided food. One out of 7 staff stated there were times when resident will say they are not going to eat dinner but changes mind, so this staff will prepare sandwich. One of the staff stated there were times when the number of trays delivered were less than the number of residents to be served, however, when this staff calls the kitchen, additional trays were delivered.

Based on observation, review of records, inspection and interviews, the allegation is 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 citation issued.

Exit interview conducted and copy of this report provided.

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Alicia Delmundo	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023

LIC9099 (FAS) - (06/04)

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