306004595-7-23-2021-22-AS-SSAS-C653QG-20210821182708

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004595
Report Date: 07/23/2021
Date Signed: 07/23/2021 11:11:07 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
09/29/2020 and conducted by Evaluator Kathrina Chin

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200929135427

FACILITY NAME:	SUNRISE ASSISTED LIVING OF FULLERTON		FACILITY NUMBER:	306004595
ADMINISTRATOR:	CHRISTIAN OTBO		FACILITY TYPE:	740
ADDRESS:	2226 N EUCLID ST		TELEPHONE:	(714) 738-3656
CITY:	FULLERTON	STATE: CA	ZIP CODE:	92835
CAPACITY:	85	CENSUS: 65	DATE:	07/23/2021
		UNANNOUNCED	TIME BEGAN:	10:20 PM
MET WITH:	Christian Otbo, Executive Director		TIME COMPLETED:	11:30 PM

ALLEGATION(S):

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Resident sustained unexplained bruising while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Kathrina Chin made an unannounced visit to the facility for the purpose of presenting the findings of the complaint investigation. Upon arrival, LPA met with Executive Director, Christian Otbo. The investigation consisted of interviews with the facility staff, Executive Director, and witnesses as well as reviewing and obtaining documentation. The following was determined:

During interviews, the facility Wellness Nurse(Staff 1) stated a small bruising observed by two caregivers (Staff 2 and Staff 3) upon a body check and found 4 bruises one on the elbow, one on the hip area, one abdomen (largest) and one on the arm. Staff 1, staff 2 and staff 3, staff 4 believe that resident 1 may have hit furniture or the sink in her room. She is often running into things. The room is full of furniture. Staff 1 and staff 2 also reported that resident 1 was started on baby aspirin a few weeks ago. LPA, Kathrina Chin interviewed the resident via FaceTime and LPA observed the room to be filled with furniture in her studio apartment. (Continued on LIC 9099c).

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina Chin	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2021

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-20200929135427

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 ASSISTED LIVING OF FULLERTON	FACILITY NUMBER: 306004595
	VISIT DATE: 07/23/2021

NARRATIVE

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LPA interviewed R1 and she said she has no idea how she got these bruises and she has not fallen. She further said that she feel well and the staff are very helpful. Resident 1 said that staff has never mistreated her.

LPA, Kathrina Chin interviewed a resident's family member who reported that resident 1 has had falls in the past and has been moving furniture in her apartment which may have resulted in bruises.

LPA interviewed Christian Otbo, Executive Director and he said that she is a fall risk and was receiving physical therapy services from UCI Medical Center for unsteady gait. Mr. Otbo further explained that R1 often did not use her walker or her cane. Mr. Otbo believes that resident 1's unexplained bruises may have been possibly due to resident's unsteady gait and bumping into her furniture.

Resident 1 has a private duty aide for 3 days a week for four hours a day. LPA Chin interviewed the private duty aide and she said that the resident is a fall risk and she was always ensuring that R1 does not fall or bump into anything. Resident lived in the Memory Care Unit.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

An exit interview was conducted with Christian Otbo and a copy of this report was provided.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina Chin	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2021

LIC9099 (FAS) - (06/04)

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