019200755-9-25-2023-15-AS-BFOG-D34UAC-20240306142428

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200755
Report Date: 09/25/2023
Date Signed: 09/25/2023 02:55:26 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
01/06/2023 and conducted by Evaluator Kelly Nguyen

COMPLAINT CONTROL NUMBER: 15-AS-20230106114026

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:	01:00 PM
MET WITH:	Deborah Savoie, Executive Director		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff did not ensure medications were dispensed as prescribed
Staff do not ensure resident medication records are properly maintained
Facility does not provide sufficient quantity of food to residents in care
Staff do not ensure special dietary needs are met for residents in care
Staff do not ensure residents health related needs are being met

INVESTIGATION FINDINGS:

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On this day, 9/25/2023 at 1:00PM 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 did not ensure medications were dispensed as prescribed: Unsubstantiated
It was alleged staff did not ensure medications were dispensed as prescribed. LPA sample of 8 residents medication administration record (MAR). 8 out of 8 residents MAR indicated that all resident’s medication
is listed per physician orders and is giving as prescribed.

Allegation: Staff do not ensure resident medication records are properly maintained: Unsubstantiated
It was alleged staff do not ensure resident medication records are properly maintained. LPA reviewed residents’ medication records data base, and sample of 8 residents medication administration record (MAR). Based on the medication data base all resident’s medication records are being kept along with the resident’s prescribed medication.

Allegation: Facility does not provide sufficient quantity of food to residents in care: Unsubstantiated
Based on LPA observation during lunch hours. LPA observed that residents are being offered a choice of food entrée. LPA observed enough plates that are being prep by the dinning staff ready to serve residents during lunch hour.

Allegation: Staff do not ensure special dietary needs are met for residents in care: Unsubstantiated
LPA reviewed resident’s physician reports 1 out of 6 residents are on a special dietary plan. LPA observed that the resident that is on a special dietary plan is being served a different type of special accommodation food plate.

Allegation: Staff do not ensure residents health related needs are being met: Unsubstantiated
During the course of investigation LPA interviewed 6 residents. 6 out of 6 residents stated that all their needs are being meet, and there’s nothing to complain about.

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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