306005223-10-19-2020-22-AS-SSAS-BUL3P9-20201020182508

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005223
Report Date: 10/19/2020
Date Signed: 10/19/2020 09:50:41 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
07/21/2020 and conducted by Evaluator James August

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200721160043

FACILITY NAME:	SUNNYCREST SENIOR LIVING		FACILITY NUMBER:	306005223
ADMINISTRATOR:	HEATHER YOST		FACILITY TYPE:	740
ADDRESS:	1925 SUNNY CREST DRIVE		TELEPHONE:	(714) 992-1999
CITY:	FULLERTON	STATE: CA	ZIP CODE:	92835
CAPACITY:	210	CENSUS: 97	DATE:	10/19/2020
		UNANNOUNCED	TIME BEGAN:	09:31 AM
MET WITH:	Heather Yost, Executive Director		TIME COMPLETED:	09:42 AM

ALLEGATION(S):

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Staff not administering medications as prescribed
Staff did not report changes in resident's condition to responsible party or physician
Resident's care needs are not being met

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jim August contacted the facility via telephone to conclude a complaint investigation via telephone due to COVID-19 and precautionary measures. LPA identified himself and discussed the purpose of the call and the elements of the allegation with Executive Director Heather Yost.
The 10-day visit was completed on July 28, 2020.

The investigation into the allegations that staff are not administering medications as prescribed, staff did not report changes in resident's condition to responsible party or physician and the resident's care needs are not being met revealed the following:
LPA August conducted the initial investigation on July 28, 2020. During the investigation, LPA interviewed one witness, Executive Director Heather Yost and three (3) staff as well as reviewed and obtained pertinent documents.
CONTINUED ON LIC9099C DATED OCTOBER 19, 2020...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: James August	TELEPHONE: 714-703-2853
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2020

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-20200721160043

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: SUNNYCREST SENIOR LIVING	FACILITY NUMBER: 306005223
	VISIT DATE: 10/19/2020

NARRATIVE

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Witness 1 (W1) stated that resident 1 (R1) was discovered to have swelling in his legs and ankles as well as overgrown toenails on July 4, 2020. W1 did not have any pictures of R1’s legs or feet. W1 also stated that R1 had a doctors appointment on July 14, 2020 wherein R1 received two (2) new medications that were to be administered within 24 hours. W1 stated that she dropped off the medications the same day to facility staff 1 (S1).

S1 stated that she never received any medications or orders directly from W1. S1 stated that she was unaware of R1 having any swelling of the feet or legs or any hygiene issues. She recalled that R1 was very independent and preferred to handle his own hygiene care.

Executive Director Yost as well as two other staff (S2 and S3) all corroborated that the new medications for R1 were brought to the facility on July 21, 2020 without orders. Executive Director Yost as well as S2 and S3 corroborated that the orders were received by W1 the night of July 23, 2020 and that the medications were administered to R1 the next morning. Executive Director Yost and S1, S2 and S3 had no knowledge of any swelling, or hygiene issues with R1. In addition, W1 did not have any documentation or photographs R1’s swelling or overgrown nails.

LPA August obtained and reviewed R1’s medical assessment as well as Medication Administration Records (MAR). The medical assessment indicates R1 does not have any cognitive impairments and is able to care for all personal hygiene needs. The MAR indicates that R1’s new medications were both administered on July 24, 2020.

As such, there is insufficient evidence to corroborate whether the above allegations have occurred. With the information obtained through the means described above, we have found the above allegations unsubstantiated. Although the allegations may have happened or may be valid; there is not a preponderance of evidence to prove that the alleged violations occurred.

An exit interview was conducted with Executive Director Yost via video-telephone and a copy of this report was provided to Executive Director Yost via email. Executive Director Yost to sign all pages of the report and return the signed copy to LPA August within 24 hours.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: James August	TELEPHONE: 714-703-2853
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2020

LIC9099 (FAS) - (06/04)

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