275202734-4-6-2021-26-AS-RMAO-BZUNY2-20210407105201

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 275202734
Report Date: 04/05/2021
Date Signed: 04/06/2021 02:16:33 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
06/24/2020 and conducted by Evaluator Joanne Roadilla

COMPLAINT CONTROL NUMBER: 26-AS-20200624115138

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: 115	DATE:	04/05/2021
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Amy Saulnier		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff did not seek timely emergency medical care for resident.
Resident became severely dehydrated in the facility.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Joanne Roadilla conducted a subsequent complaint tele-visit today to deliver investigation findings. The Department has suspended on site visits due to COVID-19 shelter in place order by Governor Newsom. LPA spoke to Amy Saulnier.

On 06/24/2020, the Department received a complaint with the allegations of neglect/lack of care and supervision wherein the facility did not seek timely emergency care for a resident (R1), and resident became severely dehydrated at the facility.

On 06/26/2020, LPA Elizabeth Larios, conducted a 10-day tele-visit inspection. LPA Larios obtained residents and staff records and conducted interviews with facility staff.

Continued on LIC9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Joanne Roadilla	TELEPHONE: (408) 205-2348
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2021

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-20200624115138

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: 04/05/2021

NARRATIVE

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For allegation that staff did not seek timely emergency medical care for resident

Between 07/02/2020 to 07/24/2020, the Department conducted interviews with R1's family members (FM). FM stated that on 05/30/2020, FM went to the facility to assist R1 eat. FM stated that R1 ate, was talking and did not appear to be sick. FM received a phone call from facility staff around 12pm on 05/31/2020, saying R1 did not look good. FM went to the facility and was able to communicate with R1 who at the time, did not want to eat and seemed weak and was then transported to the hospital at 12:54pm.

Between 07/09/2020 to 07/24/2020, the department interviewed facility staff (S1 to S5). On 04/23/2020, R1 was transported and was subsequently admitted to the hospital. 4 out of 5 staff who provide direct care to R1 stated that R1’s health started declining after R1 was discharged back to the facility from the hospital on 04/28/2020. S2 stated that facility staff provide R1 with fluids and snacks throughout the day and would update the medical technician on R1’s food and fluid intake. Based on records review, facility had memos that were faxed to R1’s doctor between 04/17/20 and 05/31/20 indicating R1’s changes in condition. Facility also had progress notes for R1 between 04/24/20 and 05/31/20 that were communicated to the family members including the facility discussing with R1’s family the possibility of R1 needing a higher level of care. FM stated R1’s physician recommended hospice, but it was not mandatory. FM did not want R1 on hospice and didn’t believe R1 was sick enough to require hospice care. FM stated that they like the facility and that the facility staff did a good job taking care of R1.

Continued on LIC9099-C.

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Joanne Roadilla	TELEPHONE: (408) 205-2348
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2021

LIC9099 (FAS) - (06/04)

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Control Number 26-AS-20200624115138

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: 04/05/2021

NARRATIVE

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For allegation that resident became severely dehydrated in the facility

During FM’s interview, FM stated that after R1 was discharged back to the facility on 04/28/20, R1’s health began declining rapidly and was not able to feed self. FM stated that R1 has not been eating well but R1 still ate food and drank water and an Ensure drink. FM stated that they hired a private caregiver to help R1 eat. FM would also come to the facility to assist R1 eat on certain days. FM stated that the last day FM assisted R1 was on 05/30/20 and R1 ate and appeared to be okay and did not appear to be sick.

On 07/09/20, the department contacted the private caregiver agency that FM hired and interviewed agency staff (AS1 and AS2). AS1 stated they were hired on 05/14/2020 to assist R1 eat because R1 wouldn’t eat unless fed. AS2 stated R1 understood that they were hired to assist R1 with eating because R1 didn’t eat enough. AS2 stated that R1 was able to communicate if R1 was tired, felt sick or was in pain. On 05/30/20, AS2 did not mention R1 appearing to be sick and needing to go to the hospital since staff document when they notice something unusual with R1. AS2 stated that R1 never complained but on 05/31/20, when AS2 arrived at the facility, R1 did not seem well and when asked how R1 felt, R1 stated “not good” so AS2 called the agency and FM to inform them of the situation. AS2 also notified staff at facility.

Based on interviews and records review, there is no preponderance of evidence to prove the allegations did or did not occur. Therefore, the Department found the above allegations to be UNSUBSTANTIATED.

No deficiencies cited during today’s compliant investigation tele-visit. Exit interview conducted with and a copy of this report e-mailed to Amy Saulnier for review and signature.

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Joanne Roadilla	TELEPHONE: (408) 205-2348
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2021

LIC9099 (FAS) - (06/04)

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