275202358-12-1-2023-26-AS-BCHN-CY8TL4-20231205134851

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 275202358
Report Date: 11/30/2023
Date Signed: 12/01/2023 11:35:27 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/17/2020 and conducted by Evaluator Vadim Gorban

PUBLIC

COMPLAINT CONTROL NUMBER: 26-AS-20200317110337

FACILITY NAME:	SUNRISE ASSISTED LIVING OF MONTEREY		FACILITY NUMBER:	275202358
ADMINISTRATOR:	BILLY M. MITCHELL		FACILITY TYPE:	740
ADDRESS:	1110 CASS ST		TELEPHONE:	(831) 643-2400
CITY:	MONTEREY	STATE: CA	ZIP CODE:	93940
CAPACITY:	112	CENSUS: 92	DATE:	11/30/2023
		UNANNOUNCED	TIME BEGAN:	11:05 AM
MET WITH:	Administrator, Kellie Shearer		TIME COMPLETED:	01:06 PM

ALLEGATION(S):

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Staff failed to provide accurate assessment for resident while in care
Staff failed to issue monitor device for resident while in care
Staff failed to notify authorized representative of resident's significant changes in condition
Resident was not provided an accurate nutritional assessment
Staff denied authorized representative access to resident's records

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) V Gorban conducted unannounced visit on 11/30/23 to conclude the complaint investigation. Upon arrival LPA met with Administrator/Licensee Kellie Shearer and stated the purpose of the visit.

A complaint was received on March 17,2020, alleging the following: Staff failed to provide accurate assessment for resident while in care; Staff failed to issue monitor device for resident while in care; Staff failed to notify authorized representative of resident's significant changes in condition; Resident was not provided an accurate nutritional assessment; Staff denied authorized representative access to resident's records. During the course of the investigation the department conducted interviews and reviewed relevant documents. Based on the information obtained during this time period, the allegations could not be confirmed or corroborated.

Report continues on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Vadim Gorban	TELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 11/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023

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 26-AS-20200317110337

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: SUNRISE ASSISTED LIVING OF MONTEREY	FACILITY NUMBER: 275202358
	VISIT DATE: 11/30/2023

NARRATIVE

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The Department has investigated the above mentioned allegations and has determined that the complaint is UNSUBSTANTIATED. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Exit interview conducted, report signed and copy of this report provided for facility records.

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Vadim Gorban	TELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 11/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023

LIC9099 (FAS) - (06/04)

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