198204069-9-29-2021-11-AS-EMAZ-C8DRVC-20211102132120

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198204069
Report Date: 09/29/2021
Date Signed: 09/29/2021 05:56:05 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/16/2021 and conducted by Evaluator Stephanie Cifuentes

COMPLAINT CONTROL NUMBER: 11-AS-20210916151040

FACILITY NAME:	SUNRISE ASSISTED LIVING OF SANTA MONICA		FACILITY NUMBER:	198204069
ADMINISTRATOR:	GOLIA, ALBERTO		FACILITY TYPE:	740
ADDRESS:	1312 15TH ST		TELEPHONE:	(310) 899-1976
CITY:	SANTA MONICA	STATE: CA	ZIP CODE:	90404
CAPACITY:	100	CENSUS: 67	DATE:	09/29/2021
		UNANNOUNCED	TIME BEGAN:	10:21 AM
MET WITH:	Myra Aragones		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Facility is not accommodating residents' food preferences that meet the residents' nutritional needs.

INVESTIGATION FINDINGS:

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On 09/29/2021, Licensing Program Analyst (LPA) Stephanie Cifuentes conducted an unannounced subsequent complaint visit at this facility. LPA met with Myra Argones Senior Executive Director and explained the purpose of today's visit is to conduct interviews regarding the allegation and deliver findings.

The investigation consisted of the following: On 9/21/2021 LPA Cifuentes conducted an interview with Executive Director Myra Argones. A review of facility files was completed and an inspection of the facility was conducted with Maintenance Director. On 9/29/2021 LPA Cifuentes interviewed residents (R1-R6) and staff (S1-S5). Copies of the following documents were requested and received: Staff and resident rosters, admissions agreement, physician’s report and other pertinent documents related to the allegations.

Continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021

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 11-AS-20210916151040

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754

FACILITY NAME: SUNRISE ASSISTED LIVING OF SANTA MONICA	FACILITY NUMBER: 198204069
	VISIT DATE: 09/29/2021

NARRATIVE

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Investigation revealed the following:

Allegation: Facility is not accommodating residents' food preferences that meet the residents' nutritional needs.

It is alleged that facility staff are changing resident’s special food preferences. LPA Cifuentes reviewed facility files. No copy of a signed agreement regarding food preferences was found in R1’s file. LPA also reviewed facility admissions agreement and found that page 18 section five states the following, “We will serve three (3) nutritionally balanced meals and snacks daily to residents at the community. These meals and snacks are included in the base fee. We will also accommodate some special diets, if prescribed by your physician as a medical necessity.” LPA reviewed physicians agreement for R1, which had an attached letter from doctor stating R1’s diagnosis and that R1 needed a diet with specific diet textures and food preparation that could be communicated by R1. No instructions as to specific foods, textures and preparation were provided by doctor. LPA Cifuentes spoke with R1, who stated they spoke to previous executive director before they moved into the facility and that executive director agreed to follow R1’s food preferences. LPA Cifuentes spoke with current Executive Director Myra Argones regarding the allegation. Per Mrs. Argones, the facility has accommodated the resident’s food preferences thus far. R1 provided their own menu to the facility with their food preferences. It is separate from the menu created by Sunrise of Santa Monica following USDA guidelines and title 22 regulations. Menu provided by R1 is for both mechanical soft and pureed foods. Facility is able to provide mechanical soft and pureed foods based on their own menu, but has had difficulty accommodating the menu specified by R1. Mrs. Argones felt it was a safety concern to serve both mechanical soft and pureed foods. A thirty-day notice was given to R1 on August 31, 2021, stating that the facility would no longer be able to serve their dietary preferences as of September 30, 2021 and that after that date, they would need to order from the regular menu. Facility reached out to make dietary preference arrangements with R1 before 9/30/2021. Interviews with residents (R3 to R6) state that residents all felt facility was accommodating their dietary needs. LPA also interviewed staff (S1-S5), who stated that facility is able to accommodate a variety of texture modified diets, which meet their residences dietary needs.

The Department’s investigation consisted of an inspection of the facility, observation, analysis of facility records and interviews conducted and found no evidence to support the allegation: " Facility is not accommodating residents' food preferences that meet the residents' nutritional needs.".

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations, did or did not occur, therefore the allegations are Unsubstantiated.

An exit interview was conducted with Mayra Aragones and a copy of the report was provided.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021

LIC9099 (FAS) - (06/04)

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