197603807-9-14-2022-31-AS-NGID-CJNMN8-20220927094504

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603807
Report Date: 09/14/2022
Date Signed: 09/14/2022 10:11:57 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/28/2022 and conducted by Evaluator Angela Panushkina

COMPLAINT CONTROL NUMBER: 31-AS-20220728144526

FACILITY NAME:	SUNRISE AT STERLING CANYON		FACILITY NUMBER:	197603807
ADMINISTRATOR:	BERRY, TAMARA		FACILITY TYPE:	740
ADDRESS:	25815 MCBEAN PKWY		TELEPHONE:	(661) 253-3551
CITY:	VALENCIA	STATE: CA	ZIP CODE:	91355
CAPACITY:	140	CENSUS: 126	DATE:	09/14/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Elizabeth Kaplan, Business Office Coordinator		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Resident has sustained multiple falls while in care

INVESTIGATION FINDINGS:

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At 9:30am, Licensing Program Analyst (LPA) Angela Panushkina made an unannounced subsequent visit to finish investigation into the allegation above. LPA met with an Executive Director and explained the reason for the visit. It is alleged that Resident #1 (R1) had multiple falls while in care resulting in injury.

LPA made the initial complaint visit on 08/04/2022. On that day LPA conducted interviews with Executive Director, Reminiscence Coordinator, Assistant Living Coordinator, 3 staff members and 12 residents. LPA also reviewed R1’s facility file and obtained copies of pertinent documents relevant to the investigation.

Interviews with an Executive Director, Reminiscence Coordinator, Assistant Living Coordinator, 3 out of 3 staff, during the initial visit, revealed that R1 used to independently leave the facility, purchase alcohol and hide it in their room. Once the facility found out about this issue, all alcohol bottles were removed from R1’s room. Interviews also revealed that the facility is monitoring R1’s alcohol intake by following R1’s Doctors’ order and having someone accompany R1 when they leave the facility. Continue on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022

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 31-AS-20220728144526

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: SUNRISE AT STERLING CANYON	FACILITY NUMBER: 197603807
	VISIT DATE: 09/14/2022

NARRATIVE

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Interviews with nine (9) out of twelve (12) residents, revealed that the facility staff checks them frequently (every 2 hours) and they feel very safe living in this facility.

In addition, LPA conducted an interview with R1’s Power of Attorney (POA) on 08/05/22 and was informed that R1 used alcohol all the time and became addicted. Interview with POA revealed that during the fall incident, R1 was intoxicated. POA stated: “I don't think Sunrise has caused anything. The facility does a great job and I don't blame them at all."

Based on information obtained through interviews and document review this allegation is deemed Unsubstantiated.

Exit interview conducted and copy of report emailed to the Administrator.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022

LIC9099 (FAS) - (06/04)

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