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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107206649
Report Date: 03/23/2022
Date Signed: 03/25/2022 09:13:58 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/10/2021 and conducted by Evaluator Alexandria Walton
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20211210164352
FACILITY NAME:SUNRISE OF FRESNOFACILITY NUMBER:
107206649
ADMINISTRATOR:BREWER, NORSHELLFACILITY TYPE:
740
ADDRESS:7444 N. CEDARTELEPHONE:
(559) 325-8170
CITY:FRESNOSTATE: CAZIP CODE:
93720
CAPACITY:89CENSUS: 74DATE:
03/23/2022
UNANNOUNCEDTIME BEGAN:
09:07 AM
MET WITH:Business Office Coordinator, Nancy CartierTIME COMPLETED:
10:08 AM
ALLEGATION(S):
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Staff are making inappropriate comments in the presence of resident's
INVESTIGATION FINDINGS:
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On 03/23/2022, Licensing Program Analyst (LPA) Walton arrived unannounced to deliver findings on the above allegation. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. Administrator is not available during this inspection, LPA met with Business Office Coordinator, Nancy Cartier.

Interviews with staff confirmed that a verbal altercation occurred between S1 and S2 in the presence of residents, family members of residents and facility staff.

Based on interviews, the preponderance of evidence standard has been met, therefore the allegation: Staff are making inappropriate comments in the presence of resident's is found to be SUBSTANTIATED

CONTINUED TO LIC9099C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:

DATE: 03/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2022
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 4
Control Number 24-AS-20211210164352
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: SUNRISE OF FRESNO
FACILITY NUMBER: 107206649
VISIT DATE: 03/23/2022
NARRATIVE
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Deficiencies are being cited in accordance to California Code of Regulations, Title 22, Division 6, on the attached 9099D.

An exit interview was conducted, and Plan of Corrections were reviewed and developed. A copy of this report and appeal rights was discussed and provided to Business Office Coordinator, Nancy Cartier, whose signature on this form confirms receipt of this document.

SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:

DATE: 03/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/10/2021 and conducted by Evaluator Alexandria Walton
COMPLAINT CONTROL NUMBER: 24-AS-20211210164352

FACILITY NAME:SUNRISE OF FRESNOFACILITY NUMBER:
107206649
ADMINISTRATOR:BREWER, NORSHELLFACILITY TYPE:
740
ADDRESS:7444 N. CEDARTELEPHONE:
(559) 325-8170
CITY:FRESNOSTATE: CAZIP CODE:
93720
CAPACITY:89CENSUS: 74DATE:
03/23/2022
UNANNOUNCEDTIME BEGAN:
09:07 AM
MET WITH:Business Office Coordinator, Nancy CartierTIME COMPLETED:
10:08 AM
ALLEGATION(S):
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Staff are forcing resident to take medication
INVESTIGATION FINDINGS:
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On 03/23/2022, Licensing Program Analyst (LPA) Walton arrived unannounced to deliver findings on the above allegation. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. Administrator is not available during this inspection, LPA met with Business Office Coordinator, Nancy Cartier.

Based on interviews conducted, the allegation: Staff are forcing resident to take medication is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

No deficiencies issued during this inspection.

An exit interview was conducted with Administrator. A copy of this report was discussed and provided to Business Office Coordinator, Nancy Cartier, whose signature on this form confirms receipt of this document.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:

DATE: 03/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 24-AS-20211210164352
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: SUNRISE OF FRESNO
FACILITY NUMBER: 107206649
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/23/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/25/2022
Section Cited
CCR
87468.1(a)
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87468.1 Personal Rights of Residents in All Facilities
(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by:
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Licensee agreed that staff will be trained on the requirements on section 87468.1 by 04/22/2022 and documentation of training topics and attendance will be submitted to the Fresno CCL office by 04/25/2022.
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Based on interviews conducted, the Licensee did not ensure residents were accorded dignity in their relationships with staff when S1 and S2 engaged in a verbal altercation in the presence of residents, resident families, and other caregivers. This poses a potential health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:

DATE: 03/23/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4