306005423-3-23-2023-22-AS-MSTC-CQK7RD-20230403215323

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005423
Report Date: 03/23/2023
Date Signed: 03/23/2023 10:19:04 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
03/09/2023 and conducted by Evaluator Jerome Haley

COMPLAINT CONTROL NUMBER: 22-AS-20230309094120

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:	03/23/2023
		UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Diana Kuhn		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Facility did not release resident records to the legal representative.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jerome Haley made an unannounced visit to redeliver the findings on the complaint allegation above. During the visit on March 16, 2023, the incorrect regulation was cited.
The report from March 16, 2023 will be amended, and the correct regulation will be cited.

Licensing Program Analyst (LPA) Jerome Haley made an unannounced visit to investigate the above complaint allegation on March 15, 2023. During the initial visit, LPA Haley interviewed facility Executive Director (ED) Bryan Reamer-Yu, to gather details regarding the complaint allegation.

Regarding the allegation, Facility did not release resident records to the legal representative.

During the initial visit LPA Haley interviewed ED Reamer-Yu regarding the allegation and it was discovered at that time, the facility received the request for records March 7, 2023, and forwarded the request for records to the facilities legal department for review to ensure protection of the records and personal information.
Continued on LIC9099

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome Haley	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 03/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2023

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-20230309094120

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: 03/23/2023

NARRATIVE

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It was confirmed during the interview during the initial visit March 15, 2023, the records had not been provided to the legal representative who requested the documents.

On March 16, 2023 during the second visit to deliver the findings on the complaint allegation, LPA Haley was informed after the facilities legal departments review was complete, the requested records were sent via email to the requesting party's legal representation.

Based on the evidence gathered, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. Violations are being cited per California Code of Regulations Title 22, Division 6, Chapter 1.

An exit interview was conducted and a copy of this report, LIC9099D, and appeal rights were provided.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome Haley	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 03/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2023

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20230309094120

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: 03/23/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/23/2023 Section Cited CCR 87506(c)(1)	1 2 3 4 5 6 7	(c) All information and records obtained from or regarding residents shall be confidential. (1) The licensee shall be responsible for storing active and inactive records and for safeguarding the confidentiality of their contents. The licensee...only upon the residents written consent or that of his designated representative.	1 2 3 4 5 6 7	Licensee will read and review CCR section 87506 Resident Records, and send LPA Haley an email confirmation when completed. POC due date is Thursday, March 30, 2023 at 3:00 PM.
	8 9 10 11 12 13 14	This requirement has not been met as evidenced by interview confirmation from Executive Director March 15, 2023 that the facilities legal department had not provided the requested documentation to the leal representatives wo made the request. This poses a potiental 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: Luz Adams	TELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome Haley	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 03/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2023

LIC9099 (FAS) - (06/04)

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