045002389-12-7-2022-25-AS-KHOS-CMLLHJ-20221230074625

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 045002389
Report Date: 12/07/2022
Date Signed: 12/07/2022 03:48:52 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/20/2022 and conducted by Evaluator Kerry Hiratsuka

COMPLAINT CONTROL NUMBER: 25-AS-20220520112752

FACILITY NAME:	SUNSHINE ASSISTED LIVING-THE COTTAGE		FACILITY NUMBER:	045002389
ADMINISTRATOR:	LARRY KREPELKA		FACILITY TYPE:	740
ADDRESS:	1468 SUN MANOR		TELEPHONE:	(530) 877-3363
CITY:	PARADISE	STATE: CA	ZIP CODE:	95969
CAPACITY:	17	CENSUS: 15	DATE:	12/07/2022
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Larry Krepelka		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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1. Resident's medications were mismanaged
2. Not enough staff to meet the resident's needs
3. Facility has residents with higher level of care needs

INVESTIGATION FINDINGS:

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LPA Hiratsuka, conducted this unannounced complaint visit. LPA wore a surgical mask and observed all staff wearing surgical masks.

LPA Hiratsuka investigated the allegations: 1. Resident's medications were mismanaged; 2. Not enough staff to meet the resident's needs; and 3. Facility has residents with higher level of care needs.

1. LPA interviewed staff and reviewed medication records. There is one resident who's medication comes in bubble pack cards and are to be administered twice a day. The bubble packs are numbered 1-30 or 1-31, depending on the month. There is one pill per bubble so the medication comes with two cards . The staff at the time used both bubble packs and labeled them for the different times. The medication passing was logged on a separate sheet. There have been a couple times the staff who were preparing the medication for dispense popped a pill from the wrong bubble pack and/or the person passing the medication logged the wrong sheet.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Kerry Hiratsuka	TELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2022

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 25-AS-20220520112752

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: SUNSHINE ASSISTED LIVING-THE COTTAGE	FACILITY NUMBER: 045002389
	VISIT DATE: 12/07/2022

NARRATIVE

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The staff who prepare the medication have since decided to use one bubble pack card at at time for both doses during the day instead of using both. That has ceased the medication count errors. The medications were not missing or not given, they were just miscounted because one bubble pack card was used or not used as it was supposed to. One bubble pack card was used twice instead of once. LPA reviewed the medication records and the counts did match.

2. LPA interviewed staff, a resident's family member, and residents. No one complained about not enough staff. There are times where it might be busier than others, but LPA was told that the staff are able to handle what is going on.

3. LPA was informed there was one resident who was identified as beyond the level of care the facility could provide shortly after the resident moved in and it was agreed by all parties the resident should move out to a higher level of care. The resident moved out.

“This agency has investigated the complaint alleging; 1. Resident's medications were mismanaged; 2. Not enough staff to meet the resident's needs; and 3. Facility has residents with higher level of care needs. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Kerry Hiratsuka	TELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2022

LIC9099 (FAS) - (06/04)

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