<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602882
Report Date: 11/17/2021
Date Signed: 11/17/2021 03:51:25 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 CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/06/2019 and conducted by Evaluator Kruz Long
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20190606110215
FACILITY NAME:SUNRISE ASSISTED LIVING OF CLAREMONTFACILITY NUMBER:
198602882
ADMINISTRATOR:MENSAH, ERICFACILITY TYPE:
740
ADDRESS:2053 N TOWNE AVETELEPHONE:
(909) 398-4688
CITY:CLAREMONTSTATE: CAZIP CODE:
91711
CAPACITY:81CENSUS: 58DATE:
11/17/2021
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Roger Endert (Executive Director)TIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident developed multiple pressure injuries while in care.
Staff failed to address resident's hygiene needs.
Staff left resident in soiled diaper for extended period of time.
Staff failed to ensure resident had adequate food intake.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Kruz Long conducted an unannounced subsequent complaint visit to the facility. Upon arrival, LPA met with Roger Endert (Executive Director) and explained the purpose of the visit.

During the initial visit on 06/07/19, LPA obtained a copy of the staff/resident roster and a physician's orders and needs and services plan for resident #1,2,3 receiving wound care.

During today's visit, LPA obtained a copy of the Staff/Resident rosters, incontinence list, interviewed Staff #1 to Staff #8 in the conference room between 10:45 am to 12:50 pm, toured the kitchen with Staff #8 at 1:55 pm and interviewed Residents #5 to #10 in their bedrooms between 2:15 pm to 3:00 pm.

Continue to LIC9099C.....
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Kruz LongTELEPHONE: (323) 383-8117
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2021
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 2
Control Number 28-AS-20190606110215
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 CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: SUNRISE ASSISTED LIVING OF CLAREMONT
FACILITY NUMBER: 198602882
VISIT DATE: 11/17/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
In regards to the allegation: Resident developed multiple pressure injuries while in care, the department investigation consisted of interviews with Staff #1 to Staff #8, review of Resident #1's medical records and facility file (Service plan, physician's order, Home Health records), Resident #1 passed away on 06/14/19, therefore, Resident #1 was not interviewed. Investigation Branch did not interview Administrator but interviewed family member and Residents #4, #7, #11, #12 and #13.

Investigation revealed that Resident #1 was admitted to home health for wound care on 04/18/19. Per treatment records dated 05/06/19 through 05/18/19, indicated Resident #1 was being treated by home health for a Stage II wound on Coccyx, Stage I wound on the left heel and a Stage 1 wound on the right heel. On 05/20/19, Resident #1 was sent to the hospital for treatment due to the Stage II pressure ulcer on the Coccyx getting worse. During the time Resident #1 was in the facility, the Resident was receiving wound care and there is no evidence to support that the facility contributed to Resident#1 developing wounds due to neglect.

In regards to the allegation: Staff failed to address resident's hygiene needs. Interviews with Residents indicate their hygiene needs are met which consist of assistance with bathing, oral/dental care, transferring, incontinence care and dressing. Interview with caregiving Staff also indicate that hygiene assistance is provided based the Residents service plan.

In regards to the allegation: Staff left resident in soiled diaper for extended period of time. Interviews with Resident requiring incontinence care reveal that they are assisted with diaper changes at least 3 to 4 times per shift and had not been left in soiled diapers for an extended period of time. Interviews with caregiving Staff also indicate incontinence care is provided on a sufficient and timely manner.

In regards to the allegation: Staff failed to ensure resident had adequate food intake. A toured of the facility kitchen revealed that there is sufficient supply of perishable and non-perishable foods. Interviews with Resident indicate that facility is providing 3 meals a day. Resident with feeding needs are receiving the proper assistance. Interviews with caregiving Staff indicate that Residents are provided 3 meals a day and Residents with feeding needs are assisted.

Based on the department's record review, observations and interviews, the investigation revealed: Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

Exit interview conducted with Roger Endert and a copy of this report provided.
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Kruz LongTELEPHONE: (323) 383-8117
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2