019200755-9-25-2023-15-AS-KHOS-CXBJ3Y-20231106054219

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200755
Report Date: 09/25/2023
Date Signed: 09/25/2023 02:54:29 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
01/03/2023 and conducted by Evaluator Kelly Nguyen

COMPLAINT CONTROL NUMBER: 15-AS-20230103132800

FACILITY NAME:	SUNRISE ASSISTED LIVING OF OAKLAND HILLS		FACILITY NUMBER:	019200755
ADMINISTRATOR:	CAGULADA, DILLON R		FACILITY TYPE:	740
ADDRESS:	11889 SKYLINE BLVD		TELEPHONE:	(510) 531-7190
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94619
CAPACITY:	100	CENSUS: 77	DATE:	09/25/2023
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Deborah Savoie, Executive Director		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff do not provide proper medication assistance to residents in care
Staff did not notify resident's physician of resident's change of condition
Staff do not implement proper COVID-19 mask guidance at the facility

INVESTIGATION FINDINGS:

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On this day, 9/25/2023 at 12:30PM Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to deliver the finding on the above allegations. LPA met with Deborah Savoie, Executive Director and explained the purpose of the visit.

Allegation: Staff do not provide proper medication assistance to residents in care: Unsubstantiated
It was alleged that Staff do not provide proper medication assistance to residents in care. LPA did a sample of 8 residents medication administration record (MAR). 8 out of 8 residents MAR indicated that all resident’s medication is provided and records properly.

Allegation: Staff did not notify resident's physician of resident's change of condition: Unsubstantiated.
It was alleged that staff did not notify resident’s physician of resident’s change of condition. LPA sample 6 residents progress notes. Based on records review of six resident shown that there is a communication exchange between facility and resident physician. Facility notifies any concerned/changes in the resident condition.

Allegation: Staff do not implement proper COVID-19 mask guidance at the facility: Unsubstantiated
It was alleged that Staff do not implement proper COVID-19 mask guidance at the facility. Based on LPA interviewed S1, S2, S5, and S7 states that everyone in the facility is required to wear a mask. Only residents that have the option of not wearing a mask. S1, S2, and S5 states that we asked staff to put on their mask whenever they are around residents. On 1/13/23 at 9:30am LPA observed front desk staff checked people temperature, and asked staffs, visitor, and encouraged residents to put on a mask.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.
Exit interview conducted and a copy of this report provided.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Kelly Nguyen	TELEPHONE: (510) 915-8702
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2023

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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