306005423-1-9-2023-22-AS-SSAS-CMY3Y5-20230110173921

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005423
Report Date: 01/09/2023
Date Signed: 01/09/2023 12:46:10 PM

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
01/03/2023 and conducted by Evaluator Michelle Reed

COMPLAINT CONTROL NUMBER: 22-AS-20230103103314

FACILITY NAME:	SUNRISE ASSISTED LIVING AT TUSTIN		FACILITY NUMBER:	306005423
ADMINISTRATOR:	BRYAN REAMER-YU		FACILITY TYPE:	740
ADDRESS:	12291 S NEWPORT AVE		TELEPHONE:	(714) 544-5959
CITY:	SANTA ANA	STATE: CA	ZIP CODE:	92705
CAPACITY:	70	CENSUS: 47	DATE:	01/09/2023
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Administrator Bryan Reamer-Yu		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Facility staff repackaged resident medications from original containers

INVESTIGATION FINDINGS:

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Licensing Program Analyst Michelle Reed arrived at the facility to discuss the complaint allegation. Upon arrival, LPA met with Administrator Bryan Reamer Yu. Interviews were conducted and records were reviewed.

On 12/16/21, it was discovered by the Regional Director of Resident Care that the Community staff were repackaging resident medications from prescription bottles to blister cards. The Community purchased a commercially available device to do the repackaging. This started in March of 2020.

The repackaging was started in response to Sunrises contract pharmacy suspending their service of repackaging medications during the Covid pandemic. Upon discovery, the repackaging was immediately stopped and the repackaged medications were identified and replaced with new medication. The responsible parties and physician's for the residents involved were notified. According to an unusual incident report submitted by Regional Director of Operations Todd Smith, an investigation was conducted and there was no evidence of medication errors, harm to residents or diversion of medications and all team members responsible for handling medications

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: Michelle Reed	TELEPHONE: (714) 743-4958
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2023

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-20230103103314

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 AT TUSTIN	FACILITY NUMBER: 306005423
	VISIT DATE: 01/09/2023

NARRATIVE

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participated in a full retraining regarding safe handling of medications.

Based upon a review of records and the interviews conducted the preponderance of evidence standard has been met and the allegation is substantiated.

See LIC9099D for cited deficiencies per Title 22 regulation.

An exit interview was conducted and a copy of this report and appeal rights were provided to Administrator Bryan Reamer-Yu.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: Michelle Reed	TELEPHONE: (714) 743-4958
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2023

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20230103103314

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 AT TUSTIN	FACILITY NUMBER: 306005423
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/09/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 01/09/2023 Section Cited CCR 87465(h)(5)	1 2 3 4 5 6 7	Incidental Medical and Dental Care-Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Director of Operations and Resident Care Director ensured retraining was conducted by 1/15/22 of all staff who had the responsibility for handling resident medications on Title 22 procedures.
	8 9 10 11 12 13 14	Facility staff repackaged resident medications from original containers into blister packs during the Covid pandemic from March 2020 until 12/16/21. This posed a health and safety risk to resident's in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Sheila Santos	TELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: Michelle Reed	TELEPHONE: (714) 743-4958
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2023

LIC9099 (FAS) - (06/04)

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