306005423-2-10-2023-22-AS-SSAS-CPP3PY-20230306172618

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005423
Report Date: 02/10/2023
Date Signed: 02/10/2023 01:20:07 PM

Unsubstantiated

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
09/22/2020 and conducted by Evaluator Patricia Velazquez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200922121220

FACILITY NAME:	SUNRISE ASSISTED LIVING AT TUSTIN		FACILITY NUMBER:	306005423
ADMINISTRATOR:	TYLER HAWK		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:	02/10/2023
		UNANNOUNCED	TIME BEGAN:	08:56 AM
MET WITH:	Bryan Reamer-Yu - Executive Director		TIME COMPLETED:	01:35 PM

ALLEGATION(S):

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Staff did not seek timely medical care for resident
Staff not giving resident PRN medication
Staff are not assisting residents with their medications

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Patricia Velazquez conducted an unannounced subsequent complaint visit to deliver the findings of the investigation into the above allegations. LPA Velazquez was allowed entry into the facility and met with Executive Director (ED) Bryan Reamer-Yu and explained the purpose of the visit.

On today's visit LPA Velazquez conducted interviews with residents and staff. LPA Velazquez requested additional records for Resident (R) #1 and R6. Regarding the allegation Staff did not seek timely medical care for resident during the course of the investigation the following was revealed: LPA Velazquez conducted interviews with residents and staff. LPA Velazquez also reviewed facility, resident, and staff records. The records reviewed included Resident Move In Record, Preplacement Appraisal Information, Physician's Reports, R1's Mission Hospice Records, New Resident Information, and Residency Admission Agreements. Additional records reviewed included Board of Vocational Nursing and Psychiatric Technicians Licensing details, Staff Training Records, and copies of Administrator Certificates for Staff (S) #1 and S7.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (713) 334-2062
LICENSING EVALUATOR NAME: Patricia Velazquez	TELEPHONE: (949) 236-0556
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023

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-20200922121220

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: 02/10/2023

NARRATIVE

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Eight of eight individuals interviewed provided conflicting statements and could not corroborate the allegation Staff did not seek timely medical care for resident with S7 stating it is the facility's policy to call 911 when indicated such as when a resident requests to go to the hospital. S7 further stated the final decision to determine if a resident needs to go to the hospital falls with the Emergency Personnel who respond to the 911 calls. The investigation revealed R6 was sent out to the hospital on or about September 17, 2020 after continued complaints of pain.

Based on the observations made, interviews which were conducted and the records that were reviewed, 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 following allegation: Staff did not seek timely medical care for resident is deemed UNSUBSTANTIATED.

Regarding the allegations Staff not giving resident PRN medication and Staff are not assisting residents with their medications during the course of the investigation the following was revealed: LPA Velazquez conducted interviews with residents and staff. LPA Velazquez also reviewed facility, resident, and staff records. The records reviewed included Resident Move In Record, Preplacement Appraisal Information, Physician's Reports, R1's Mission Hospice Records, New Resident Information, Resident Medication Administration Records, and Residency Admission Agreements. Additional records reviewed included Board of Vocational Nursing and Psychiatric Technicians Licensing details, Staff Training Records, and copies of Administrator Certificates for Staff (S) #1 and S7. Thirteen of thirteen individuals interviewed provided conflicting statements and could not corroborate these 2 allegations. Five of five individuals stated they were provided their routine medications as prescribed by their doctors as well as their PRN medication when needed. Two of five individuals interviewed stated they managed their own medications and would take their PRN medication when needed. Seven of eight individuals interviewed stated they follow physician's orders regarding a resident's medication administration with some individuals indicating that some residents sometimes forget that they have already received a dose of their PRN medication. S5 stated the facility utilizes the Point Click Care (PCC) Electronic Medication Administration Record (MAR) system where staff document each time a medication is administered or if it is refused by the resident. The PCC MAR documents various Chart Codes and

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (713) 334-2062
LICENSING EVALUATOR NAME: Patricia Velazquez	TELEPHONE: (949) 236-0556
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 22-AS-20200922121220

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: 02/10/2023

NARRATIVE

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Follow-Up Codes to document such things as a resident spitting out a medication and when the medication was administered and actually consumed by a resident.

Based on the observations made, interviews which were conducted and the records that were reviewed, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the following allegations: Staff not giving resident PRN medication and Staff are not assisting residents with their medications are also deemed UNSUBSTANTIATED.

An exit interview was conducted with Executive Director Bryan Reamer-Yu and a copy of this report along with the LIC 811s were provided at the time of this visit.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (713) 334-2062
LICENSING EVALUATOR NAME: Patricia Velazquez	TELEPHONE: (949) 236-0556
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023

LIC9099 (FAS) - (06/04)

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