306004562-10-7-2020-22-AS-AORZ-BUBW3B-20201012165538

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004562
Report Date: 10/07/2020
Date Signed: 10/07/2020 02:22:07 PM

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
02/05/2020 and conducted by Evaluator Rosie Quiroz

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200205161415

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: 147	DATE:	10/07/2020
		UNANNOUNCED	TIME BEGAN:	01:09 PM
MET WITH:	Luis Rodriguez, Administrator		TIME COMPLETED:	01:35 PM

ALLEGATION(S):

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-Resident sustained multiple falls while in care
-Resident sustained an injury while in care
-Resident was left unattended for an extended period of time
-Resident was left soiled for an extended period of time
-Facility did not ensure resident had clean clothing
-Residents are not being accorded dignity in their personal relationships with staff

INVESTIGATION FINDINGS:

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On today's date, Licensing Program Analyst (LPA) Rosie Quiroz contacted the facility for the purpose to deliver findings for a complaint investigation via telephone due to COVID-19 and pre-cautionary measures.
The initial 10-day visit was completed on 2/14/2020. During the initial 10 day visit, LPA Quiroz obtained copies of Resident’s (R1’s) Physician’s Report, R1's care plan, Resident Roster, Staff Roster and Staff Schedules for December 2019-February 2020, R1's progress notes from 5/14/2018-1/30/2020. R1's Order Summary report, R1's Residential Agreement and Care plans for Resident 2 (R2), Resident 3(R3), Resident 4 (R4), Resident 5 (R5), Resident 6 (R6) and Resident 7 (R7).
It was alleged that "Resident sustained multiple falls while in care." During the course of this investigation, LPA Quiroz conducted multiple interviews with interviewees, reviewed documents including but not limited to progress notes from 5/14/2018-1/30/2020, R1's care plan, physician report dated 10/4/2018, R1's Summary Report, and R1's residential agreement Physician report for R1 dated 10/4/2018, which reflects R1 with a diagnose of Dementia. According to Physician report dated 10/4/2018, R1 was listed as non-ambulatory status.
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Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie Quiroz	TELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2020

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-20200205161415

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 SEAL BEACH	FACILITY NUMBER: 306004562
	VISIT DATE: 10/07/2020

NARRATIVE

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Physician report dated 10/4/2018 under Mental condition documents R1 is able to feed self, able to care for own toileting needs, able to communicate needs, able to follow instructions, sun-downing behavior, wandering behavior, confused and disoriented. Per R1's care plan conducted on date of admission on 7/2/2017, R1 is able to communicate needs, resident has history of wandering within the residence or facility, resident requires assistance with dressing, undressing and selecting clothing but resident is able to assist with tasks with step by step cueing. R1 requires physical assistance of 1 person for bathing and needs step by step cueing assistance for toileting. Documents observed do not indicate R1 requiring a 1:1 supervision at all times. Per documents reviewed and interviews conducted with interviewees; 7 of 7 Interviewees could not verify whether or not resident sustained multiple falls while in care. Therefore based on preponderance of evidence gathered, the Allegation "Resident sustained multiple falls while in care." is deemed to be 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, therefore the allegation is UNSUBSTANTIATED

It was alleged that "Resident sustained an injury while in care." During the course of this investigation, LPA Quiroz conducted multiple interviews with interviewees, reviewed documents including but not limited to progress notes from 5/14/2018-1/30/2020. Documentation revealed that falls dated between 5/14/2018-1/30/2020 included full body check, responsible party notification and did not include any injuries to resident, which did not require emergent medical attention. 7 of 7 Interviewees reported monitoring resident and evaluating for changes in range of motion, vital signs and change in condition or status such as pain, skin discoloration, swelling, difficulty moving an extremity, change in mental status, onset of confusion, sleepiness, inability to maintain posture or agitation as stated in resident's care plan. Per documents reviewed and interviews conducted with interviewees; 7 of 7 Interviewees could not verify whether or not resident sustained an injury while in care. Therefore based on preponderance of evidence gathered, the Allegation "Resident sustained an injury while in care." is deemed to be 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, therefore the allegation is UNSUBSTANTIATED

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SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie Quiroz	TELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2020

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20200205161415

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 SEAL BEACH	FACILITY NUMBER: 306004562
	VISIT DATE: 10/07/2020

NARRATIVE

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It was alleged that "Resident was left unattended for an extended period of time," "Resident was left soiled for an extended period of time," "facility staff did not ensure resident had clean clothing" and "Residents are not being accorded dignity in their personal relationships with staff." During the course of the interview, it was reported that during a family visit on 2/2/2020, R1 was observed in the dining room by herself in a chair and was asleep with no care givers around and that R1 had soiled herself (bowel movement) and foul odor was detected on R1; which appeared to have happened some time earlier prior to the visit. Interviewee reported that they informed two caregivers that R1's laundry basket was full, that she was out of clothes that fit her, and her laundry needed to be done, especially the soiled clothes from the bowel movement in her pants. Interviewee reported they followed up on 2/3/20 and that R1's laundry was not done, the soiled clothes remained in her room, which they reported as being "unsanitary."
During the course of this investigation, LPA Quiroz conducted multiple interviews with interviewees, and conducted observations during an unannounced inspection tour of the facility on 2/14/2020 and reviewed documents but not limited to R1 physician report, R1's care plan, laundry list schedule for R1 and staff schedules for December 2019-February 2020. During facility inspection tour, LPA Quiroz observed activity group in Reminiscence unit being conducted by Life Enrichment Manager. There were 13 residents present during the group. LPA Quiroz observed R1 sitting on the couch inside the activity room sleeping. LPA Quiroz observed 3 care managers also present during the group supervising the residents during group activity.
After activity group ended, LPA Quiroz observed residents escorted to dining room. LPA Quiroz observed R1 to be the last resident to be escorted to dining room for lunch. 6 of 6 interviewees reported R1 preferred to sleep and be seated last to avoid sleeping on table while waiting for meal to be served. R1's care plan reflects under Dining and Nutrition "Observe for and report any change in the assistance I require for dining," and "Offer me a choice in my seating preference and ensure I am comfortable with my table mates." During transport from couch to wheelchair, LPA Quiroz observed R1's clothes and observed around couch where resident was sitting prior to being transferred onto wheelchair as she was being escorted to dining room for lunch. R1 did not appear to be soiled and was wearing weather appropriate and clean clothing. LPA Quiroz joined residents in the dining-room as lunch was being served. LPA Quiroz observed caregivers appropriately engaging with residents, and did not observe any disrespect of dignity towards the residents. Caregivers were observed to be ethical, respectful, addressing residents respectfully and appropriately engaging with the residents during lunch meal. During the inspection tour, LPA Quiroz did not note any foul odor in the facility, activity rooms, or resident's bedrooms. LPA Quiroz did not note any foul odor in the dining room while residents ate their lunch.
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SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie Quiroz	TELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2020

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20200205161415

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 SEAL BEACH	FACILITY NUMBER: 306004562
	VISIT DATE: 10/07/2020

NARRATIVE

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During inspection tour along with Administrator Luis Rodriguez. LPA Quiroz toured R1, R2 and R3's bedrooms, No foul odor was noted in 3 of 3 resident bedrooms, Clean clothes were observed in 3 of 3 resident bedrooms, and 3 of 3 resident Bedrooms. 3 of 3 Resident's bathrooms and bedrooms were found to be within Title 22 California Code of Regulations.
Per documents reviewed, observations and interviews conducted with interviewees; 7 of 7 Interviewees could not verify whether or not "Resident was left unattended for an extended period of time," "Resident was left soiled for an extended period of time," "facility staff did not ensure resident had clean clothing" and "Residents are not being accorded dignity in their personal relationships with staff." Therefore based on preponderance of evidence gathered, the Allegations "Resident was left unattended for an extended period of time," "Resident was left soiled for an extended period of time," "facility staff did not ensure resident had clean clothing" and "Residents are not being accorded dignity in their personal relationships with staff." are deemed to be UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is no preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

An exit interview was conducted with Administrator Luis Rodriguez via telephone and a copy of this report was provided via email. An electronic email read receipt, confirms receiving these documents. Administrator agreed to receive the copies of the report and to return a signed copy to Community Care Licensing and LPA Quiroz timely.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie Quiroz	TELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2020

LIC9099 (FAS) - (06/04)

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