306005223-2-15-2024-22-AS-AORZ-D2VPAA-20240228100827

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005223
Report Date: 02/15/2024
Date Signed: 02/15/2024 10:52:24 AM

Substantiated

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
08/17/2023 and conducted by Evaluator Rosie Quiroz

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230817163330

FACILITY NAME:	SUNNYCREST SENIOR LIVING		FACILITY NUMBER:	306005223
ADMINISTRATOR:	MELANIE WASHINGTON		FACILITY TYPE:	740
ADDRESS:	1925 SUNNY CREST DRIVE		TELEPHONE:	(714) 992-1999
CITY:	FULLERTON	STATE: CA	ZIP CODE:	92835
CAPACITY:	210	CENSUS: 89	DATE:	02/15/2024
		UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Melanie Washington, Executive Director		TIME COMPLETED:	10:04 AM

ALLEGATION(S):

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-Staff did not make medication inaccessible to resident, resulting in hospitalization.

INVESTIGATION FINDINGS:

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On today's date, Licensing Program Analyst (LPA) Rosie Quiroz conducted an unannounced visit to deliver findings on an investigation completed by the Department. LPA Quiroz was greeted and granted entry into the facility by Front desk receptionist and met with Melanie Washington, Executive Director and explained the reason for the visit.
During the course of the investigation, the Department interviewed staff and witnesses as well as reviewed and obtained pertinent documentation including Physician Report. The purpose of today’s visit is to deliver the findings regarding the above allegation. The investigation conducted revealed the following:
Resident 1 (R1) was admitted to the facility on April 1, 2023, and has a diagnosis of history of Transient Ischemic Attack (TIA) per Physician report dated June 8, 2023. Per Physician report resident is not able to administer or store their own medication.
On August 12, 2023, Staff 1 (S1) reported being busy finishing tasks before the end of their shift and passed off medication duty to another MedTech, Staff 2(S2), to finish distributing.
CONTINUED...

Substantiated

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: 02/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024

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-20230817163330

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: 02/15/2024

NARRATIVE

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CONTINUED...S1 reported placing R1’s medication and a second resident, Resident 2 (R2)’s medication into white cups with their room numbers written on it. S1 signed off on both R1 and R2 taking their medications based on verbal information received from S2. S1 and S2 did not physically see residents take their medications.
On the morning of August 13, 2023, R1 saw a white cup with medications on the nightstand and assumed they were for them and ingested them. When S1 came in to do R1’s morning medication disbursement, S1 found out S2 had left medications for R2 on R1’s dresser and didn’t distribute them like they had said they did the night before. Shortly after taking the wrong Medications, R1 became lethargic and unresponsive and was transported to St.Jude Hospital and returned to the facility later that night.
On August 15, 2023, approximately two days after being hospitalized for ingesting the wrong medications, R1 was getting showered by a caregiver and once again became lethargic and unresponsive and was transferred to St. Jude Hospital. St. Jude Hospital medical records state R1 suffered from a stroke and was diagnosed with a cerebral blood clot causing R1 to undergo surgery.
Medication Administration Records (MARs) for R1 show R1 had a prescription for Eliquis to be taken 1 tablet by mouth twice daily. Interviews conducted with Administrator Melanie Washington confirmed R1 missed their evening dose of medication on 8/13/23 due to returning back to the facility late after being hospitalized. The morning of 8/15/23, facility staff were prepared to administer R1’s medications but did not due to R1’s medical emergency causing them to be re-hospitalized.
Due to R1 being hospitalized two times as a result to taking the wrong medication, R1 missed their Eliquis medication doses. Per Medical Expertise received by the Department, R1’s missed Eliquis medication was a contributing factor to R1 having a blood clot/stroke.
Upon finding out R1 ingested another resident’s medication, Facility Administrator Melanie Washington conducted an internal investigation and determined that facility protocol had not been followed. Both S1 and S2 were terminated.
Therefore, based on interviews conducted and records reviewed, the preponderance of evidence has been met. The allegation that staff did not make medication inaccessible to resident, resulting in hospitalization has been Substantiated.
The facility is being cited per Title 22, Division 6 of the California Code of Regulations.
A Civil Penalty is pending determination by Community Care Licensing Division as per Health & Safety Code 1569.49(f).
An exit interview was conducted, and a copy of this report, 9099-D Page, and appeal rights was left at the facility.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie Quiroz	TELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20230817163330

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/15/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 02/16/2024 Section Cited CCR 87465(c)(2)	1 2 3 4 5 6 7	87465(c)(2) Incidental Medical and Dental Care- …Once ordered by the physician the medication is given according to the physician's directions… This requirement was not met as evidence by: Licensee failed to ensure R1 received prescribed Eliquis medication twice CONTINUED...	1 2 3 4 5 6 7	Facility hired a medication room Manager who is an addition to MT Staff to ensure proper medication administration and agreed to conduct inservice training to all personnel administering medication and submit proof of medication training by POC due date of 2/20/2024.
	8 9 10 11 12 13 14	CONT... daily resulting in at least one missed dosage on the dates 8/13/23 and 8/15/23. As a result, R1 suffered a stroke and was diagnosed with a cerebral blood clot requiring surgery. This poses an immediate health and safety risk to residents in care.	8 9 10 11 12 13 14
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie Quiroz	TELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024

LIC9099 (FAS) - (06/04)

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