198204069-8-18-2022-11-AS-MVAO-CHRS2T-20220829133002

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198204069
Report Date: 08/18/2022
Date Signed: 08/18/2022 11:13:01 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/29/2021 and conducted by Evaluator Jey Cardenas

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20211129135919

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: 62	DATE:	08/18/2022
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Milton Pineda		TIME COMPLETED:	11:10 AM

ALLEGATION(S):

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Facility staff sexually assaulted resident.
Facility staff are not following resident's care plan.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jey Cardenas conducted a subsequent complaint visit to facility to deliver complaint findings for the allegations listed above. Upon arrival at the facility LPA met with Miton Pineda maintenance coordinator and conducted a Covid-19 risk assessment; based on the assessment; the facility is clear of Covid-19 infection.

The investigation consisted of the following: LPA Cardenas reviewed Resident#1 (R1) facility file and obtained copies of documents relevant to the allegations, obtained resident and staff roaster, interviewed staff #2-#7 (S2-S7) and residents #2-#8 (R2-R8) R9 refused to be interviewed.
It is alleged that facility caregiver inspected R1s genital area without residents’ consent, therefor sexually assaulted resident. According to Reporting Party (RP) inspecting R1’s genitals is not part of the sunrise care plan.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Jey Cardenas	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022

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 3

Control Number 11-AS-20211129135919

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: SUNRISE ASSISTED LIVING OF SANTA MONICA	FACILITY NUMBER: 198204069
	VISIT DATE: 08/18/2022

NARRATIVE

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(continued pg 2)
Per Physician Report from Sunrise Assisted Living Santa Monica dated 8/3/2021 R1 has dementia is confused/ disoriented, has sundowning behavior, and is not able to leave facility unassisted. R1 is not able to store own medication. Per Primary Care Physician (PCP) letter written 3/16/2020 “due to chronic condition, both physical and cognitive, R1 needs ongoing assistance from caregivers to help with activities of daily living which is essential to residents’ safety. On 12/24/21 R1 was moved to Atria Park of Pacific Palisades; Per Physician Report from Atria Park of Pacific Palisades dated 2/24/22 R1 is diagnosed with Dementia: Capacity for self-care; not able to: bathe self, dress groom/self, able to care for own toileting needs.

Per Unusual Incident Report (UIR): On 11/28/2021 at approximately 1PM R1 attempting to leave the community and was observed rubbing genital area and complaining of pain. R1 was redirected, and family was notified. Staff have also reported redness/ skin breakdown in in residents’ genitals while providing care.

-Regarding allegation Facility staff sexually assaulted resident: On 11/30/21 LPA Cardenas interviewed Reporting RP who indicates that a Sunrise caregiver inspected R1s genitals by force and reported that genital area was red, swollen, and had lesions. R1 would not consent to a genital inspection, R1 is self reliable and capable of caring for own personal hygiene needs. R1 has not complained about sexual abuse, nor mentioned any genital discomfort. LPA was not given consent from family to interview R1 due to resident is nocturnal and doesn’t not like being disturbed. On 12/07/21 LPA received an email from RP withdrawing complaint against facility. RP mentioned that facility must have lied as an excuse to move R1 from assisted living unit into memory care and increase payment rate. On 12/06/2021 LPA Cardenas interviewed S2 who indicates that on 11/28/21 R1 was attempting to leave facility. S2 noticed R1 was wearing a soiled gown and scratching lower-body part including genitals. During a recent stand up meeting S3 told her that R1 was facing bedroom door and was observed with button down gown wide opened. Staff observed from afar that there was skin breakdown and what appeared to be a rash in the genital area, no physical contact was made. On 12/13/2021 LPA interviewed S3 who does not recall observing or reporting such incident, S3 denies conducting any genital inspection body check on R1. S2-S7 indicated that none of the residents have reported sexual abuse, nor witnessing any sexual abuse. S4 indicates family is restricting staff from doing their job and rendering care. Last month R1 had dry scaly skin and kept scratching all over the body. Staff don’t have consent to apply lotion because staff are not allowed to touch resident. On 12/06/2021 LPA interviewed R2-R8 who indicate that they feel safe at the facility. R2-R8 have

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Jey Cardenas	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20211129135919

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: SUNRISE ASSISTED LIVING OF SANTA MONICA	FACILITY NUMBER: 198204069
	VISIT DATE: 08/18/2022

NARRATIVE

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(continued pg 3)

not been sexually abused at the facility; they have no concerns regarding sexual abuse.

-Regarding allegation Facility staff are not following resident's care plan. LPA reviewed Care Plan updated 11/28/21- assessment completed due to change in condition, forgetful short attention span, confused about environment. Current skin condition- dry skin bilateral lower legs. Assistance in the bathroom- support needed; Intervention: assistance to the bathroom routine perform a skin check to see if residents skin is clear, dry, and free of breakdown, redness or swelling.

Per interview conducted with RP on 11/30/21 RP indicates that there is no agreement for anyone to check R1s genitals, care plan doesn’t mention inspections as part of services. R1 is private and won’t allow anyone to assist with personal hygiene. LPA interviewed Executive Director Matan who indicates that care plan is followed by staff. Staff have not forced R1 to do a body check nor genital inspections. Staff are instructed to check in on residents, if residents refuse services, it is their right and staff will respect their decision. On 5/16/22 LPA Cardenas interviewed Matan who indicates that new staff is trained on care plans during their onboarding orientation. In addition, during cross-over shifts at least three times a day, the care coordinator conducts stand up meeting regarding resident’s care plan and if any changes were noted; from a resident fall, to skin breakdown, or hospitalizations will be reported. During interviews with S2-S7 residents have not expressed concerns to the staff regarding their care plans not being followed. During interview with S5, staff indicates they carry a tablet with resident’s care plan, plan will let staff know services residents require. Care plan notes; needs with dressing, transferring, showering etc. On 12/06/2021 LPA interviewed R2-R8. R2-R7 have no concerns regarding their care plan, services needed are being provided. R5 is self-sufficient and says doesn’t need much care. R8 indicates that care plan is not being followed ; resident is on a shower schedule and on today at 2:30pm someone should have come up to shower resident. Its past 2:30 and no one has showed up.

Based on interviews and records reviewed there’s not sufficient evidence to support the allegation. 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, therefore the allegation is deemed unsubstantiated. There were no deficiencies cited during todays visit. Exit interview conducted and a copy of this report and appeal right provided facility representative.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Jey Cardenas	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022

LIC9099 (FAS) - (06/04)

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