306002644-9-7-2023-22-AS-AORZ-CX5QMC-20231031121715

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306002644
Report Date: 09/07/2023
Date Signed: 09/07/2023 02:35:29 PM

Unfounded

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
08/02/2023 and conducted by Evaluator Jessica Cho

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230802084533

FACILITY NAME:	SUNRISE OF MISSION VIEJO		FACILITY NUMBER:	306002644
ADMINISTRATOR:	PSENECNIK, ROXANNE		FACILITY TYPE:	740
ADDRESS:	26151 COUNTRY CLUB DRIVE		TELEPHONE:	(949) 582-2010
CITY:	MISSION VIEJO	STATE: CA	ZIP CODE:	92691
CAPACITY:	110	CENSUS: 85	DATE:	09/07/2023
		UNANNOUNCED	TIME BEGAN:	01:19 PM
MET WITH:	Maria Domingo- Executive Director		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff did not monitor the resident's health changes.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jessica Cho arrived unannounced for the purpose to deliver the findings into the above allegation. LPA stated the purpose of the visit to Executive Director (ED) Maria Domingo and reviewed the allegation. On August 4, 2023, LPA initiated the complaint investigation visit. Interviews were conducted with residents and staff, and LPA obtained copies of pertinent resident records. The following was revealed during the course of the investigation:

It is alleged that the staff did not monitor the resident’s health changes. Resident #1 (R1) was admitted to the facility on August 6, 2022. On August 27, 2022, R1 was hospitalized due to a behavioral episode and was diagnosed with Hypocalcemia. Upon review of the Physician's Move In Orders/Prescriptions dated August 3, 2022, it was determined that R1’s primary care physician did not prescribe R1 calcium upon admission to the facility; and as result, causing R1 to exhibit severe symptoms. It was confirmed with four out of four individuals whom have indicated that R1’s attending physician is/was not employed or affiliated with the facility.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Jessica Cho	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023

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-20230802084533

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 OF MISSION VIEJO	FACILITY NUMBER: 306002644
	VISIT DATE: 09/07/2023

NARRATIVE

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Additionally, seven out of the eight residents expressed that their change of condition was continuously monitored by the facility staff and was not concerned about their care. One resident refused to participate in the interview.

Therefore, this agency has investigated the complaint and based on the interviews which were conducted and the records that were reviewed, the allegation: Staff did not monitor the resident’s health changes is deemed UNFOUNDED. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.

An exit interview was conducted with Executive Director Maria Domingo, and a copy of this report was emailed to the Executive Director at the end of the visit.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Jessica Cho	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023

LIC9099 (FAS) - (06/04)

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