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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 275202358
Report Date: 04/12/2023
Date Signed: 04/12/2023 06:23:31 PM

Substantiated


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
11/30/2022 and conducted by Evaluator Malia Thao
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20221130134408
FACILITY NAME:SUNRISE ASSISTED LIVING OF MONTEREYFACILITY NUMBER:
275202358
ADMINISTRATOR:PAUL L. HARRISONFACILITY TYPE:
740
ADDRESS:1110 CASS STTELEPHONE:
(831) 643-2400
CITY:MONTEREYSTATE: CAZIP CODE:
93940
CAPACITY:112CENSUS: 69DATE:
04/12/2023
UNANNOUNCEDTIME BEGAN:
10:24 AM
MET WITH:Penny Zehnder, Senior Resident Care CoordinatorTIME COMPLETED:
06:50 PM
ALLEGATION(S):
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9
Facility does not have an administrator
Staff do not follow prescribed special diets
COVID protocol is not followed
INVESTIGATION FINDINGS:
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On 4/12/23 at 10:24 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct a complaint inspection. LPA explained reason for inspection and met with Senior Resident Care Coordinator Penny Zehnder (PZ).

LPA conducted interviews and reviewed records. Based on interviews and records reviewed, LPA found that the facility does not have an Administrator, staff do not follow prescribed special diets, and COVID protocol was not followed. Facility has not hired or designated a qualified Administrator since the last Administrator resigned on 11/21/22. PZ provided some documents for designated Administrator but was incomplete and there is no evidence to show the documentation was sent to CCL. Although the facility documents residents' special diets, kitchen staff do not know who has special diets and could not identify what special diets need to be followed or served. LPA found that R1 is diabetic but is served the same food or regular diet as other non-special diet residents. R1's physician's report states R1 is to have a special diet that is low carb and low sweets. Continue on LIC9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) -341-3274
LICENSING EVALUATOR NAME: Malia ThaoTELEPHONE: 559-470-9001
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023
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 6
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
11/30/2022 and conducted by Evaluator Malia Thao
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20221130134408

FACILITY NAME:SUNRISE ASSISTED LIVING OF MONTEREYFACILITY NUMBER:
275202358
ADMINISTRATOR:PAUL L. HARRISONFACILITY TYPE:
740
ADDRESS:1110 CASS STTELEPHONE:
(831) 643-2400
CITY:MONTEREYSTATE: CAZIP CODE:
93940
CAPACITY:112CENSUS: 69DATE:
04/12/2023
UNANNOUNCEDTIME BEGAN:
10:24 AM
MET WITH:Penny Zehnder, Senior Resident Care CoordinatorTIME COMPLETED:
06:50 PM
ALLEGATION(S):
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2
3
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5
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9
Resident room is not kept free of odor
INVESTIGATION FINDINGS:
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13
On 4/12/23 at 10:24 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct a complaint inspection. LPA explained reason for inspection and met with Senior Resident Care Coordinator Penny Zehnder (PZ).

LPA made observations and conducted interviews during the course of the investigation. Although LPA observed R5's room with a strong urine odor during the inspection on 12/7/22, the facility has since replaced the carpet and treated the subfloor. Therefore the above allegation is unsubstantiated.

Exit interview conducted. A copy of this report was given to Senior Resident Care Coordinator Penny Zehnder, whose signature on this form confirms receipt of these documents.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) -341-3274
LICENSING EVALUATOR NAME: Malia ThaoTELEPHONE: 559-470-9001
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 6
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
11/30/2022 and conducted by Evaluator Malia Thao
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20221130134408

FACILITY NAME:SUNRISE ASSISTED LIVING OF MONTEREYFACILITY NUMBER:
275202358
ADMINISTRATOR:PAUL L. HARRISONFACILITY TYPE:
740
ADDRESS:1110 CASS STTELEPHONE:
(831) 643-2400
CITY:MONTEREYSTATE: CAZIP CODE:
93940
CAPACITY:112CENSUS: 69DATE:
04/12/2023
UNANNOUNCEDTIME BEGAN:
10:24 AM
MET WITH:Penny Zehnder, Senior Resident Care CoordinatorTIME COMPLETED:
06:50 PM
ALLEGATION(S):
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2
3
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5
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8
9
Facility staffing is inadequate to meet resident needs
Resident oral hygiene needs are not being met
Food safety protocols are not followed
INVESTIGATION FINDINGS:
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On 4/12/23 at 10:24 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct a complaint inspection. LPA explained reason for inspection and met with Senior Resident Care Coordinator Penny Zehnder (PZ).

LPA made observations, conducted interviews, and reviewed records. Based on observations, interviews, and record review, LPA found that facility staffing is adequate to meet resident needs, resident oral hygiene needs are being met, and food safety protocols are being followed. The allegations are false, could not have happened, and/or is without a reasonable basis.

Exit interview conducted. A copy of this report was given to Senior Resident Care Coordinator Penny Zehnder, whose signature on this form confirms receipt of these documents.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) -341-3274
LICENSING EVALUATOR NAME: Malia ThaoTELEPHONE: 559-470-9001
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 24-AS-20221130134408
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: 04/12/2023
NARRATIVE
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Continued from LIC9099.

Multiple staff stated only diabetic food item offered to residents are sugar-free desserts. R2's physician report lists a food allergy for shrimp.S1 stated the kitchen staff still served R2 shrimp and R2 was not given another food option when advised by S1. S2 and S10 stated S11 reported being symptomatic while working and was told to continue working S11's shift.

Deficiencies are being cited based on LPA's observation, interviews conducted, and record review in accordance with the California Code of Regulations, Title 22, see LIC9909D.

An exit interview was conducted and Plans of Corrections were reviewed and developed with PZ. A copy of this report and appeal rights were discussed and left with Senior Resident Care Coordinator Penny Zehnder, whose signature on this form confirms receipt of these documents.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) -341-3274
LICENSING EVALUATOR NAME: Malia ThaoTELEPHONE: 559-470-9001
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 24-AS-20221130134408
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/12/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/13/2023
Section Cited
CCR
87405(a)
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87405 Administrator - Qualifications and Duties (a) All facilities shall have a qualified and currently certified administrator…

This requirement is not met as evidenced by:
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Licensee will submit proof of designated and qualified Administrator, to include written notification designating Administrator signed by Licensee authorized signer as shown on record, high school diploma or equivalent, LIC308, LIC9182, valid CA ID/DL, health screening, to CCL by POC due date.
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Facility has not hired or designated a qualified Administrator since the last Administrator resigned on 11/21/22, this poses an immediate health, safety, or personal rights risk to residents in care. PZ provided some documents for designated Administrator but was incomplete and there is no evidence to show the documentation was sent to CCL.
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Type B
04/26/2023
Section Cited
CCR
87555(b)(7)
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87555 General Food Service Requirements
(b) The following food service requirements shall apply: (7) Modified diets prescribed by a resident's physician as a medical necessity shall be provided.

This requirement is not met as evidenced by:
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Licensee will submit proof of an in-service training roster for all staff about resident special/modified diets and encouraging healthy choices for residents that need it, to CCL by POC due date.
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LPA found that although the facility documents residents' special diets, kitchen staff do not know how to follow the special diets and could not indicate what special diets were being followed. LPA found that R1 is diabetic but is served the same food or regular diet as other non-special diet residents. Multiple staff stated only diabetic food item offered to residents are sugar-free desserts. S1 stated R2 has a food allergy and is not given another food option replacement. This poses a potential health or personal rights risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) -341-3274
LICENSING EVALUATOR NAME: Malia ThaoTELEPHONE: 559-470-9001
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 24-AS-20221130134408
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/12/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/26/2023
Section Cited
CCR
87468.1(a)(2)
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87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.

This requirement is not met as evidenced by:
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Licensee will submit proof of an in-service training roster for all staff, to include supervisors, about the facility's staff testing, isolation, and quarantine procedures, to CCL by POC due date.
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During interviews, S2 and S10 stated S11 reported being symptomatic while working and was told to continue working S11's shift. This poses a potential health and personal rights risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) -341-3274
LICENSING EVALUATOR NAME: Malia ThaoTELEPHONE: 559-470-9001
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023
LIC9099 (FAS) - (06/04)
Page: 6 of 6