306004564-1-11-2024-22-AS-AORZ-CZQS9W-20240122124123

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004564
Report Date: 01/11/2024
Date Signed: 01/11/2024 11:54:46 AM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
11/20/2020 and conducted by Evaluator Jenifer Tirre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20201120122918

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: 92	DATE:	01/11/2024
		UNANNOUNCED	TIME BEGAN:	09:14 AM
MET WITH:	Executive Director, Justine Ortiz		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident sustained unexplained bruising while in care

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced inspection to deliver findings on a complaint investigation. LPA identified herself and discussed the purpose of the visit and the elements of the allegations with Executive Director Justine Ortiz.
During course of the investigation, the Department interviewed staff, residents and witnesses as well as review and obtained pertinent documentation. The investigation conducted revealed the following:
It was reported that Resident 1 (R1) was hospitalized on November 09, 2020. During R1’s hospitalization, R1 was observed to have unusual bruising in the perinatal area. Interviews with hospital staff confirmed R1 was noted to have bruising and redness to the peri area.
Facility records dated 6/2/2020 note that R1’s skin integrity was intact. Prior to R1’s hospitalization, facility records dated 10/29/2020; 9/28/2020; and 8/29/2020 notated that R1’s skin was intact and continued to receive barrier cream applied to both buttocks to minimize redness. A review of R1’s needs and service plan
CONTINUED ON 9099C

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Jenifer Tirre	TELEPHONE: (714) 401-6844
LICENSING EVALUATOR SIGNATURE:	DATE: 01/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 2

Control Number 22-AS-20201120122918

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: SUNRISE OF HUNTINGTON BEACH	FACILITY NUMBER: 306004564
	VISIT DATE: 01/11/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

notes that R1 was at risk for skin integrity impairment and the facility was aware and treating R1’s discoloration to bilateral buttocks. Facility staff were documented to be applying physician prescribed cream twice daily and assist R1 with repositioning to avoid prolonged pressure.

Hospital discharge summary dated November 12, 2020 notes that R1 was diagnosed with thrombocytopenia and deem venous thromboembolism which could cause easy bleeding according to Mayo Clinic. Resident was discharged and placed on hospice unrelated to bruising. Facility incident report dated 11/18/2020 notes R1 passed away on hospice while at facility.

Interviews with six of six residents reported feeling safe and comfortable while at the facility and that staff treat them well. Interviews with four of four staff reported no concerns of unusual bruising on R1 and/or other residents in care.

Therefore, based on a records reviewed and interviews conducted, the allegation that Resident sustained unexplained bruising while in care was determined to be 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 and a copy of this report along with a confidential names list was provided at the time of exit.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Jenifer Tirre	TELEPHONE: (714) 401-6844
LICENSING EVALUATOR SIGNATURE:	DATE: 01/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2