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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 275202358
Report Date: 12/07/2022
Date Signed: 12/07/2022 06:11:44 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
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: 73DATE:
12/07/2022
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Asha Prasad, Business Office CoordinatorTIME COMPLETED:
06:45 PM
ALLEGATION(S):
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Facility is in disrepair.
INVESTIGATION FINDINGS:
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On 12/7/22 at 9:30 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct an initial 10-day complaint inspection. LPA explained reason for inspection and met with Business Office Coordinator (BOC) Asha Prasad. Regional Director Herman Marquez was available by telephone.

LPA made observations and conducted interviews. LPA observed the bottom half of the wall in the hallway next to room 120 in memory care was observed open with dry wall removed approximately 6 ft by 3ft. Facility provided documentation showing date of loss as 10/18/22 and service was provided for water mitigation. LPA observed doorknob of secured door to "staff only" area on the lower level, where a bio hazard closet, laundry room, maintenance room, and break room was located, was broken and did not lock, with latch bolt missing. Therefore, the above allegation is substantiated.

Continue on LIC9099C.
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: 12/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2022
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 5
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
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: 73DATE:
12/07/2022
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Asha Prasad, Business Office CoordinatorTIME COMPLETED:
06:45 PM
ALLEGATION(S):
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2
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9
Electrical outlet is exposed.
INVESTIGATION FINDINGS:
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On 12/7/22 at 9:30 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct an initial 10-day complaint inspection. LPA explained reason for inspection and met with Business Office Coordinator (BOC) Asha Prasad. Regional Director Herman Marquez was available by telephone.

LPA toured facility and made observations. LPA observed open wall in hallway of memory care unit, but electrical outlet box was covered on the sides and had an outlet cover installed. No electrical wires were exposed. Therefore the above allegation is unfounded.

Exit interview conducted. A copy of this report was given to Business Office Coordinator Asha Prasad, whose signature confirms receipt of this report.
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: 12/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2022
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 5
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: 12/07/2022
NARRATIVE
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A deficiency is being cited based on LPA observations and interviews conducted in accordance with the California Code of Regulations, Title 22, see LIC9099D.

An exit interview was conducted and Plans of Corrections were reviewed and developed with Regional Director via telephone. A copy of this report and appeal rights were given to Business Office Coordinator Asha Prasad, 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: 12/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 5
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: 12/07/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/16/2022
Section Cited
CCR
87303(a)
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87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.

This requirement is not met as evidenced by:
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Maintenance replaced the security doorknob for "staff only" area on the lower level during the inspection. LPA verified newly installed secured doorknob was operational. Licensee will submit proof of drywall replaced for wall next to room 120 to CCL by POC due date.
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LPA observed the bottom half of the wall in the hallway next to room 120 in memory care was observed open with dry wall removed approximately 6 ft by 3ft. Facility provided documentation showing date of loss as 10/18/22 and service was provided for water mitigation. LPA observed doorknob of secured door to "staff only" area on the lower level, where a bio hazard closet, laundry room, maintenance room, and break room was located, was broken and did not lock, with latch bolt missing. Which poses a potential health, safety, 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: 12/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5