306002568-9-22-2020-22-AS-SSAS-BTPNL4-20200922103254

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306002568
Report Date: 09/21/2020
Date Signed: 09/22/2020 08:20:29 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/11/2020 and conducted by Evaluator Kathrina Chin

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200511135637

FACILITY NAME:	SUNRISE AT YORBA LINDA		FACILITY NUMBER:	306002568
ADMINISTRATOR:	MARIA DOMINGO		FACILITY TYPE:	740
ADDRESS:	4792 LAKEVIEW AVE		TELEPHONE:	(714) 693-5368
CITY:	YORBA LINDA	STATE: CA	ZIP CODE:	92886
CAPACITY:	93	CENSUS: 79	DATE:	09/21/2020
		UNANNOUNCED	TIME BEGAN:	01:49 PM
MET WITH:	Maria Domingo, Executive Director		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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1) Residents have infected pressure injuries.
2) Residents are not getting their needs met.
3) Residents are forced to get up early due to insufficient staff.
4) Unqualified staff are assisting residents with administration of creams.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Kathrina Chin contacted the facility via telephone for the purpose of presenting the findings of the complaint investigation due to COVID-19 and pre-cautionary measures. LPA Chin identified herself and discussed the findings with Maria Domingo, Executive Director.

Allegation 1- Residents have infected pressure injuries.

On May 15, 2020, Maria Domingo, Executive Director stated that R1 is receiving wound care from a home health nurse, Kevin Pascual from Accent Care Home Health visits the resident twice a week and a PA(Physician Assistant) once a week via tele-health. Ms. Domingo further reported that R2 is provided wound care by the Wellness Nurse, Emily Purcell who is an RN. LPA reviewed Ms. Purcell's report which indicated that the pressure injury is a Stage I and there was no infection indicated. (Cont'd on LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina Chin	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2020

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 22-AS-20200511135637

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: SUNRISE AT YORBA LINDA	FACILITY NUMBER: 306002568
	VISIT DATE: 09/21/2020

NARRATIVE

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On May 18, 2020, LPA Chin interviewed Kevin Pascual, a wound care nurse from Accent Home Health over the telephone and he said that the pressure injury for R1 is Stage I and it is not infected. It is located on the buttocks. Mr. Pascual stated that resident is not as active such as walking because residents are staying in their rooms due to COVID-19 lockdown. Mr. Pascual reported that there is no neglect. Resident is alert and able to communicate his needs.

The Department has investigated the complaint alleging that residents have infected pressure injuries. Based on the information gathered during the investigation and review of all documents obtained, the allegation is deemed unsubstantiated. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur.

Allegation 2- Residents are not getting their need met.

It was alleged that a Geri-chair was ordered by the hospice agency for R3 and it was not used for the benefit of the resident. Maria Domingo, Executive Director says their company does not allow the use of Geri-chairs because it is considered as a form of restraint. Ms. Domingo stated the Geri chair was brought to the facility and the chair was taken back by the hospice agency.

The Department has investigated the complaint alleging that residents are not getting their needs met. Based on the information gathered during the investigation and review of all documents obtained, the allegation is deemed unsubstantiated. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur.

Allegation- 3 - Residents are forced to get up early due to insufficient staff.

Maria Domingo, Executive Director stated that all residents are staying in their rooms and meals are delivered in their apartment unit due to COVID-19 lockdown. Ms. Domingo denies that staff force residents to get up early. She said that there is no need to get the resident up early because the residents are remaining in their rooms. She further indicated that they have sufficient staff. LPA reviewed LIC 500(Personnel Report) schedules and there is sufficient staff on record. Staff have bathing schedules that caregivers follow. Ms. Domingo further explained that all staff have received personal rights training and that residents should not be forced to wake up in order to be bathed. (Continued on LIC 9099C)

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina Chin	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2020

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20200511135637

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: SUNRISE AT YORBA LINDA	FACILITY NUMBER: 306002568
	VISIT DATE: 09/21/2020

NARRATIVE

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On September 21, 2020, LPA interviewed Julie Ramirez, Health Care Manager stated that residents are never forced to wake up in order to have them bathe. LPA also interviewed Carola Garcia, Lead Care Manager. Ms. Garcia reported that if a staff cannot work there shift,and the shift is not picked up by another staff, then the Lead Care Manager will cover the shift and bathe the residents according to the bathing schedule. Ms. Garcia further explained that residents have the right to refuse and they are never forced to get up early in order to be showered.

The Department has investigated the complaint alleging that residents are forced to get up early due to insufficient staff. Based on the information gathered during the investigation and review of all documents obtained, the allegation is deemed unsubstantiated. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur.

Allegation 4- Unqualified staff are assisting residents with administration of creams
On August 28, 2020, LPA, Kathrina Chin interviewed Lead Care Manager, Aurora Martinez said that skin barriers/lotion are being used on residents for about 20 residents to prevent rashes done after changes of incontinent briefs and after bathing. Ms. Martinez said that Medication Technicians apply the medicated creams with a prescription to residents. LPA also interviewed Julie Ramirez, Health & Wellness Director/LVN who also stated that regular skin lotions are applied on residents by the caregivers. The medicated skin lotions/barriers are applied by Medication Technicians who have the required medication training.

Maria Domingo, Executive Director stated that the skin barrier creams are the only thing that caregivers are applying on residents and for the medicated skin barrier creams with prescriptions, these creams are only applied by the Medication Technicians who have the required training.

The Department has investigated the complaint alleging that unqualified staff are assisting residents of administration of creams. Based on the information gathered during the investigation and review of all documents obtained, the allegation is deemed unsubstantiated. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur.

An exit teleconference was conducted with Maria Domingo, Executive Director and LPA Chin discussed and read this report. A copy of this report will be provided via email along with the appeal rights. Maria Domingo agreed to confirm the receipt of the document, review the report and return a signed copy.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina Chin	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2020

LIC9099 (FAS) - (06/04)

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