306004562-5-12-2023-22-AS-SSAS-CS42NU-20230522173315

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004562
Report Date: 05/12/2023
Date Signed: 05/12/2023 03:50:10 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 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
04/21/2023 and conducted by Evaluator Kevin Saborit-Guasch

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230421101238

FACILITY NAME:	SUNRISE OF SEAL BEACH		FACILITY NUMBER:	306004562
ADMINISTRATOR:	LUIS RODRIGUEZ		FACILITY TYPE:	740
ADDRESS:	3850 & 3840 LAMPSON AVE		TELEPHONE:	(562) 594-5788
CITY:	SEAL BEACH	STATE: CA	ZIP CODE:	90740
CAPACITY:	261	CENSUS: 118	DATE:	05/12/2023
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Sandra Robles, Business Office Coordinator		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Unlawful Eviction

Licensee did not notify responsible party of change in condition

Licensee unlawfully increased rate

INVESTIGATION FINDINGS:

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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of delivering findings into the investigation of the three allegations listed above. LPA was greeted and granted entry by Sandra Robles, Business Office Coordinator after introducing himself and the purpose of the visit.

An initial investigation visit was conducted on April 25, 2023. LPA requested and obtained resident records for resident R1, including an initial physician report dated June 1, 2021 prior to the resident's admission at the facility. The medical assessment states a primary diagnosis of dementia and indicates that the resident has a history of confusion, inappropriate, wandering and sundowning behavior prior to his admission. LPA requested for additional documentation to be provided via email at the earliest convenience. Three staff interviews were conducted during the visit.
Additional documents requested were provided by the facility on May 1, 2023.
CONTINUED ON FORM LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023

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-20230421101238

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: SUNRISE OF SEAL BEACH	FACILITY NUMBER: 306004562
	VISIT DATE: 05/12/2023

NARRATIVE

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CONTINUED FROM FORM LIC9099-C
Regarding the allegation of Unlawful Eviction, the following has been concluded: Based on interviews conducted and a review of records, it was determined that following an increase in the frequency and severity of the resident R1's behavior episodes and aggressive acts towards facility staff, the resident's responsible party were involved in a telephone care conference during which they were notified of the necessity to either seek alternative placement in a more suitable facility or put a one-on-one companion in place for the resident through a third party. The content of the care conference was later confirmed in an email to the responsible party that was added to the complaint file. This is found to be in accordance with the terms of the admission agreement concluded between the facility and the resident's responsible party. Five days following the implementation of the one-on-one, the resident was voluntarily moved to a facility deemed to be more suitable to the type of cognitive impairment he suffers. Given the voluntary nature of the move and the fact that the terms of the admission agreement were followed through the proceedings, it cannot be concluded that an eviction did occur. Therefore the allegation is deemed Unsubstantiated, meaning that although the allegation may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violation occurred.
Regarding the allegation that Licensee did not notify responsible party of change in condition, the following has been concluded: There is ample evidence of a documented thread of notification directed at resident R1's responsible party from the Progress notes provided to LPA during the investigation with at least 13 individual contacts occurring between March 3, and April 20, 2023. Therefore the allegation is deemed Unsubstantiated, meaning that although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.
Regarding the allegation that Licensee unlawfully increased rate, the following has been concluded: The resident's base rate for services was unaffected. The additional cost incurred was due to the voluntarily contracting of a one-on-one caregiver. As a result, the allegation is deemed Unsubstantiated, meaning that although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.
A consultation was provided to facility staff on the necessity to clearly state that moving a resident from the facility or contracting a third-party one-on-one caregiver are decision that are at the absolute discretion of the resident's responsible parties and that no immediate removal would follow as a result of a refusal to follow the directives. This would however constitute ground to file a 30-day eviction notice as described in California Code of Regulations Section 87224. An exit interview was conducted and a copy of this report was provided to a facility representative.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023

LIC9099 (FAS) - (06/04)

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