306004564-10-13-2020-22-AS-AORZ-BUFUKL-20201016153920

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004564
Report Date: 10/13/2020
Date Signed: 10/13/2020 08:42:52 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
06/29/2020 and conducted by Evaluator Jenifer Tirre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200629165039

FACILITY NAME:	SUNRISE OF HUNTINGTON BEACH		FACILITY NUMBER:	306004564
ADMINISTRATOR:	MENSAH, ERIC		FACILITY TYPE:	740
ADDRESS:	7401 & 7351 YORKTOWN AVE		TELEPHONE:	(714) 536-3032
CITY:	HUNTINGTON	STATE: CA	ZIP CODE:	92648
CAPACITY:	142	CENSUS: 97	DATE:	10/13/2020
		UNANNOUNCED	TIME BEGAN:	08:35 AM
MET WITH:	Administrator, Eric Mensah		TIME COMPLETED:	08:44 AM

ALLEGATION(S):

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Severe neglect resulting in resident being malnourished.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jenifer Tirre spoke with Administrator Eric Mensah via telephone due to COVID-19 precautionary measures to discuss the findings for the above allegations. The Investigation consisted of interviews conducted with Memorial Care Long Beach Medical Center personnel, family members, Primary Physician, and Sunrise of Huntington Beach Staff. This investigation revealed the following:

On 6/29/20 The Department received allegations that Resident was neglected causing malnourishment and dehydration. Per a review of Resident 1 (R1)’s Medical Records and Interviews, it was revealed that R1 had a decline in health prior to being hospitalized on 6/26/20 at 4:44 PM. R1’s hospital medical records revealed that upon arrival R1 had poor appetite, difficulty swallowing, generalized weakness, difficulty going to bathroom, and had a diagnosis of Parkinson’s Disease.On 6/26/20 the Hospital Medical records document “no evidence of abuse or neglect” under Abuse/Neglect Screening as well as no notes of neglect were documented by any tending doctor. On 6/25/20 R1’s family requested R1 to be placed on hospice care after Sunrise staff had contacted the family about R1’s declining condition. CONT. ON 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Jenifer Tirre	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2020

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-20200629165039

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 HUNTINGTON BEACH	FACILITY NUMBER: 306004564
	VISIT DATE: 10/13/2020

NARRATIVE

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R1’s family stated R1 had a history of health challenges. Per Interview’s with R1’s family, R1 has had multiple oral surgeries, bad teeth and more recently began to exhibit self-neglect due to lack of appetite. Multiple interviews conducted reported that R1’s family were in constant contact and routinely face timed with R1. R1’s family reported they had no reason to believe caretakers were neglecting R1’s hygienic oral needs and had no concerns.

Per interviews conducted, 7 out of 7 interviewees reported the facility to be the opposite of neglectful and denied the allegation. During interviews care being provided was reported to be “fantastic” and “outstanding”. R1’s Primary Care Physician (PCP) was consulted by the tending doctors at the hospital as R1 has been a patient of PCP for nearly 30 years. The PCP states that R1 has been declining in health since suffering a hip injury back in 2018. PCP stated that R1’s lowered nutritional status was due to aging and a natural decline of health. Interviews also revealed R1 began to decline a week or two before being hospitalized and R1 ate less and refused hygienic services/assistance. R1 was discharged on 6/29/20 at 5:05PM back to the facility and placed on Hospice Care.

Therefore, based on interviews conducted and documents reviewed, the Department has found that the complaint was Unsubstantiated meaning 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 interview was conducted with Administrator via telephone and a copy of report along with LIC 811 Confidential Names List was provided to AD Mensah via email and an electronic email read receipt confirms receiving these documents. A hard copy will be kept on file.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Jenifer Tirre	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2020

LIC9099 (FAS) - (06/04)

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