197603807-3-13-2024-31-AS-NMAN-D59RRP-20240514131529

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603807
Report Date: 03/13/2024
Date Signed: 03/13/2024 03:34:35 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, 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
09/27/2023 and conducted by Evaluator Abeye Duguma

COMPLAINT CONTROL NUMBER: 31-AS-20230927105003

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: 128	DATE:	03/13/2024
		UNANNOUNCED	TIME BEGAN:	10:46 AM
MET WITH:	Tammy Berry, Executive Director		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Resident developed pressure injuries due to neglect

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced subsequent complaint visit to the facility to investigate the above allegation. LPA met with the Executive Director, Tammy Berry, and explained the reason for the visit.

--- Resident developed pressure injuries due to neglect.

It was alleged that Resident #1 (R1) developed bedsores from not being turned enough. To investigate the allegation, on 10/02/2023 LPA requested pertinent documents at 11:30 AM and interviewed three (03) staff from 12:30 PM to 02:00 PM. Record review revealed that R1 was admitted to the hospital on 05/09/2023 and 08/05/2023 for failure to thrive. On both occurrences, R1 was admitted with no pressure injuries and subsequently released from the hospital with the need to provide care for pressure injuries.

(CONT. on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2024

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-20230927105003

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: 03/13/2024

NARRATIVE

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R1 was discharged from the hospital 08/15/2023 with physician’s orders to begin receiving hospice services. R1’s pressure injuries were initially healing and then progressed from stage two (02) to stage three (03) and four (04) under hospice care. During interviews with staff, all staff stated they have six (06) to eight (08) staff providing hands on care for about four (04) to six (06) residents per shift. All staff stated that R1 was checked on and rotated every two (02) hours or less, as instructed by the hospice agency.

Based on record review and interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

No health and safety hazards noted during the visit.

Exit interview was conducted and a copy of report was issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2024

LIC9099 (FAS) - (06/04)

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