306005423-5-15-2024-22-AS-AJLO-D5RTXN-20240530150723

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005423
Report Date: 05/15/2024
Date Signed: 05/15/2024 03:48:23 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
09/25/2020 and conducted by Evaluator Claudia Gutierrez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200925171154

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: 49	DATE:	05/15/2024
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Sandra Acosta-Louer		TIME COMPLETED:	04:05 PM

ALLEGATION(S):

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Facility staff restrained resident.
Facility staff did not administer resident medications.
Facility staff not assisting resident with toileting and hygiene.

INVESTIGATION FINDINGS:

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An unannounced Complaint Investigation was conducted on this day by Licensing Program Analyst (LPA) Claudia Gutierrez regarding the allegations mentioned above and for the purpose of delivering findings. LPA met with Administrator (AD) Sandra Acosta-Louer and explained the purpose of the inspection.

Interviews were conducted with three facility staff, and five residents regarding the allegation, facility staff restrained resident. Per Reporting Party (RP), Resident 1 (R1) would “become combative” and during one of those instances Staff 1 (S1) grabbed R1 by the shoulders and restrained them to a chair for two minutes. Three out of three staff interviewed denied personally restraining any resident or witnessing any other facility staff restraining any resident, and stated restraining residents is against facility policy. LPA attempted to contact S1, but S1 could not be reached to confirm or deny allegation. R1 could not be interviewed as they have since passed away. Four out of five residents interviewed denied being personally restrained by staff. One out of five residents was unable to confirm or denied if they have been personally restrained by staff. (Cont. LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Claudia Gutierrez	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2024

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-20200925171154

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: 05/15/2024

NARRATIVE

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Two out of five residents interviewed denied witnessing staff restraining other residents and three out of five were unable to confirm or deny if they have witnessed staff restraining other residents.

Interviews were conducted with three facility staff, and five residents regarding the allegation, facility staff did not administer residents' medications. Three out of three staff interviewed denied having knowledge of facility staff not administering residents’ medication and stated designated staff administers routine medication as prescribed and PRN medication as needed. Three out of five residents interviewed stated their medication is managed by the facility and they are assisted routinely or as needed. Two out of five residents could not corroborate the allegation and were unable to confirm or deny if staff manage or administer their medication.

Interviews were conducted with three facility staff, and five residents regarding the allegation, facility staff not assisting resident with toileting and hygiene. One out of three staff interviewed denied having knowledge of facility staff not assisting residents with toileting and hygiene. Two out of three staff interviewed stated that they and other facility staff on their shift assist residents with toileting and hygiene, but stated staff on different shifts will on occasion not assist residents with toileting or hygiene. Two out of five residents could not corroborate the allegation and were unable to confirm or deny if staff assist them with toileting or hygiene. One out of five residents stated they are assisted with toileting and hygiene and two out of five residents stated they do not need assistance with toileting or hygiene, but stated they can request and will receive assistance from staff when needed

Due to conflicting information received during interviews conducted, LPA is unable to determine if facility staff restrained resident, if facility staff did not administer resident medications, or if facility staff did not assist resident with toileting and hygiene. Although the above 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 at this time the above allegations are unsubstantiated.

An exit interview was conducted and copy of this report was provided at the end of the inspection.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Claudia Gutierrez	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2024

LIC9099 (FAS) - (06/04)

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