275202734-7-27-2020-26-AS-RMAO-BRX5ZS-20200727202426

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 275202734
Report Date: 07/27/2020
Date Signed: 07/27/2020 04:01:06 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/07/2020 and conducted by Evaluator Gladys Kuizon

PUBLIC

COMPLAINT CONTROL NUMBER: 26-AS-20200107145148

FACILITY NAME:	SUNRISE VILLA SALINAS		FACILITY NUMBER:	275202734
ADMINISTRATOR:	KRISAHN NIXON		FACILITY TYPE:	740
ADDRESS:	1320 PADRE DRIVE		TELEPHONE:	(831) 754-5532
CITY:	SALINAS	STATE: CA	ZIP CODE:	93901
CAPACITY:	185	CENSUS: 138	DATE:	07/27/2020
		UNANNOUNCED	TIME BEGAN:	09:22 AM
MET WITH:	Amy Saulnier, Executive Director		TIME COMPLETED:	09:40 AM

ALLEGATION(S):

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Staff didn't follow proper eviction procedures for resident.
Staff did not know how to handle fall risk residents.
Staff did not respond to resident's call for assistance in a timely manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA-GK) Gladys Kuizon conducted a complaint tele-visit today to deliver investigation findings for the above allegations. Due to COVID-19 preventive measures, LPA-GK discusssed the findings with Executive Director (ED), Amy Saulnier, via tele-conference.

On January 7, 2020, the Department received a complaint that facility staff didn't follow proper eviction procedures for resident, staff did not know how to handle fall risk residents, and staff did not respond to resident's call for assistance in a timely manner.

On January 17, 2020, LPA Elizabeth Larios (LPA-EL) conducted an initial complaint investigation visit. During visit, LPA-EL reviewed and obtained staff and resident records.

Continued, see LIC 9099-C, page 2 of 3.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Gladys Kuizon	TELEPHONE: (408) 834-2558
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2020

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 26-AS-20200107145148

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: SUNRISE VILLA SALINAS	FACILITY NUMBER: 275202734
	VISIT DATE: 07/27/2020

NARRATIVE

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Staff did not follow proper eviction procedures for resident
On January 17, 2020, LPA-EL met with and interviewed facility Executive Director (ED) Amy Saulnier. Based on the information gathered with ED, resident (R1) was never evicted from the facility. ED stated that the facility consulted with R1's responsible party (RP) if they could relocate R1 to Sunrise Assisted Living in Monterey which is better equipped to serve R1's needs as this facility is a low acuity facility and they are not allowed to use a Hoyer lift. ED stated that neither R1 nor R1's RP was issued an eviction notice.

On January 9, 2020, LPA-EL interviewed R1's RP. RP stated that R1 required two-person assists from bed to wheelchair without a Hoyer lift. RP stated that the facility did not have a Hoyer lift. RP stated that R1's health declined and was subsequently put under hospice care. RP stated that R1 was never evicted from the facility nor relocated to Sunrise Assisted Living in Monterey.

Staff did not know how to handle fall risk residents
On January 17, 2020, LPA-EL met with ED. ED stated that facility direct care staff are not required to use a gait belt in the facility nor is it part of their program design. ED stated that R1 was receiving physical therapy and a physical therapist uses a gait belt when walking R1. ED also stated that facility staff have received fall risk training and LPA-EL was able to verify and review facility's fall prevention training for staff.

Based on reporting party's statement on January 9, 2020, R1 was observed falling slowly to the ground while being walked by staff (S1) towards R1's bed. S1 was unable to get R1 off the floor.

On January 17, 2020, staff (S1) was interviewed. S1 stated that R1 was in R1's living room when S1 was assisting R1 with R1's undergarment. R1 was standing up and holding on to R1's walker when R1's knees gave in. S1 stated that R1 had an assisted fall and S1 called for assistance from another staff to help R1. S1 stated the facility does not use gait belts.

Staff did not respond to resident's call for assistance in a timely manner
Based on allegation, a resident (R2) who has severe dementia occupies a room next to R1's. R2 is heard yelling for help but staff does not provide assistance.

Continued, see LIC 9099-C, page 3 of 3.

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Gladys Kuizon	TELEPHONE: (408) 834-2558
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2020

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 26-AS-20200107145148

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: SUNRISE VILLA SALINAS	FACILITY NUMBER: 275202734
	VISIT DATE: 07/27/2020

NARRATIVE

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ED confirmed during January 17, 2020 interview that R2 has severe dementia and staff is aware of R2's diagnosis. R2 continuously yells for help even though R2 does not need help from staff. ED stated that staff responds to residents' calls in a timely manner.

LPA-EL attempted to interview R2. Due to R2's severe dementia, R2 was not able to answer LPA-EL's questions and provide information on whether R2's needs are being met.

On January 17, 2020, LPA-EL interviewed 5 staff members. 5 out of 5 staff denied the allegations. They stated that they respond to R2's needs timely. They stated that R2 had a tendency to continuously yell for help and/or pull call lights. They stated that R2 can be impatient and demands help from staff right away.

This Department has investigated these allegations. Based on interviews conducted, records reviewed and LPA's observation, the Department has found that these allegations are UNFOUNDED, meaning that the allegations are false, could not have happened and/or are without a reasonable basis.

No deficiencies were cited. This report was discussed with and a copy emailed to Executive Director Amy Saulnier for signature.

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Gladys Kuizon	TELEPHONE: (408) 834-2558
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2020

LIC9099 (FAS) - (06/04)

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