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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 315001968
Report Date: 05/04/2023
Date Signed: 05/04/2023 06:42:13 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/18/2023 and conducted by Evaluator Sabrina Calzada
PUBLIC
COMPLAINT CONTROL NUMBER: 25-AS-20230118165958
FACILITY NAME:SUNRISE OF ROCKLINFACILITY NUMBER:
315001968
ADMINISTRATOR:MORADHASEL, ROUZBEHFACILITY TYPE:
740
ADDRESS:6100 SIERRA COLLEGE BLVDTELEPHONE:
(916) 632-3003
CITY:ROCKLINSTATE: CAZIP CODE:
95677
CAPACITY:82CENSUS: 52DATE:
05/04/2023
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Marianne Richardson, Administrator TIME COMPLETED:
06:45 PM
ALLEGATION(S):
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Staff did not provide adequate supervision resulting in resident wandering away from facility.
Staff did not safeguard resident's personal items.
Staff did not provide authorized representative copies of resident's record.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to finish a complaint investigation and deliver findings. LPA met with Marianne Richardson, Administrator, and explained purpose of inspection. During today's inspection, LPA discussed allegations further with Administrator, Memory Care Coordinator and Business Office Director and reviewed additional documentation from resident's (R1) file.

During the course of the investigation, LPA conducted additional interviews with Resident Care Director (RCD), resident's responsible person (RP), and the Ombudsman. LPA reviewed documentation pertaining to R1, including, but not limited to: physician's report, pre-appraisal, care plan, Medication Administration Record (MAR), charting notes, Power of Attorney document, email correspondences, hospital medical records, admission agreement, billing statements, and faciility visitor log.

The results of the investigation are as follows:
cont on 9099C(1)...
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 10
Control Number 25-AS-20230118165958
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
FACILITY NAME: SUNRISE OF ROCKLIN
FACILITY NUMBER: 315001968
VISIT DATE: 05/04/2023
NARRATIVE
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9099C(1)...Resident (R1) moved to the facility on/around 7/13/22. Resident’s physician’s report, dated 7/6/22, notes resident has a diagnosis of Dementia, is confused/disoriented, is unable to leave the facility unattended and needs medication management due to Dementia. Pre-appraisal states that resident is ambulatory and is able to walk without any physical assistance and is able to mentally and physically follow signs. Pre-appraisal also notes that resident needs special observation/night supervision due to confusion, forgetfulness or wandering.

Allegation: Staff did not provide adequate supervision resulting in resident wandering away from facility. Complaint alleges that resident was able to leave the facility unattended due to the alarm system not working and/or insufficient staffing.

Staff interviews and resident charting notes document that resident first left the community unattended on 8/28/22 and again on 12/2/22. Charting notes entered on 8/28/22 note that at approximately 1:45 pm, resident left the outside garden area where she was sitting in memory care after eating her lunch. Notes also document that the Assisted Living Med-Tech heard on walkie that Memory Care caregiver announced that the alarm in Memory Care was going off and resident found way out of locked back gate in Memory Care and was walking up the hill. Charting notes entered later in the day on 8/28/22 indicate that “patio doors are locked so they will alarm if she goes out the back door…. Resident will need 1:1 care if she continues exit seeking behaviors”. All staff was advised to do frequent checks on resident to include how she is doing and her whereabouts".

Charting notes entered on 12/2/22 document resident's elopement and resident's responsible person was notified by telephone voice mail and a return call was requested. Administrator stated that when resident eloped to the back enclosed parking lot, resident's 1:1 caregiver was talking to another caregiver and staff heard the delayed egress go off. Administrator confirmed there were (3) staff on shift and resident was never out of sight from staff and did not sustain any damage or injuries. Administrator confirmed an incident report (LIC624) was submitted to the Department following each elopement; however, a citation has not been issued.

Based on information obtained, LPA finds the allegation to be SUBSTANTIATED- a finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. cont on 9099C(2)...
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 10
Control Number 25-AS-20230118165958
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
FACILITY NAME: SUNRISE OF ROCKLIN
FACILITY NUMBER: 315001968
VISIT DATE: 05/04/2023
NARRATIVE
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9099C(2)... Allegation: Staff did not safeguard resident's personal items. Complaint alleges that (2) original oil paintings were missing upon resident moving out in January 2023.
Resident’s representative/responsible person (RP)stated there were a total of (3) paintings that disappeared; however, the third one "suddenly appeared" on R1's bed when she was moving out on 1/6/23. described the painting as an epitaph of a Mexican man. RP stated he did not notice any of the (3) paintings to be missing until "about a week before moving out" on 1/6/23. RP confirmed the paintings were not documented in resident's initial inventory upon move in. RP stated to LPA on 2/6/23 that R1 valued the first painting at $5K and the second painting at $3K, totaling $8K. and that R1 has approximately 50 paintings of hers, and he has all but 2 currently in his possession. RP told LPA the one missing painting is of R1's mother's house and the second one is of an Afghan female woman with green eyes. RP indicated he did not file a police report at the time he noticed the paintings were not in R1's room, as he didn't think of it at the time, but later filed one on 2/14/23 and provided a copy to LPA.

Memory Care Coordinator stated that "(R1) was a wonderful artist-- she had many loose canvasses and some were unframed and of different sizes-Some canvasses were under her bed and behind the bed and also a number of stacked paintings near the fridge". Administrator stated "missing paintings were never mentioned until move out" and RP visited resident regularly. The facility visitor log shows resident’s RP visited regularly from July 2022- January 6, 2023, for a total of approximately (31) visits.

Progress notes, entered on 1/4/23, state that on 1/3/23, ,RP stated to MCC that a staff told him she saw another resident's family member walk away with the paintings. When MCC discussed this scenario with RP and the caregiver, the caregiver did not recall this conversation at all.

Administrator confirmed the facility did not complete an initial inventory of R1's belongings, stating RP "waived it". LPA observed a blank LIC624 to be stamped "Waived" in R1's file when reviewing it. Administrator also confirmed the facility did not document the paintings that were reported as missing in January 2023 on the Resident Theft and Loss Record (LIC09060).

Based on information obtained, the facility did not meet each requirement of its Theft and Loss Policy, per Health and Safety Code 1569.153. LPA finds the allegation to be SUBSTANTIATED- a finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. cont on 9099C(2)...
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 10
Control Number 25-AS-20230118165958
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

FACILITY NAME: SUNRISE OF ROCKLIN
FACILITY NUMBER: 315001968
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/04/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/26/2023
Section Cited
CCR
87705(c)(4)
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87705 Care of Persons with Dementia
(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (4) There is an adequate number of direct care staff to support each resident’s physical, social, emotional, safety and health care needs as identified in his/her current appraisal. This requirement is not met as evidenced by:
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Licensee/Administrator implemented a 1:1 caregiver, 24/7 for R1. Follow up training was conducted in September 2022 regarding resident elopments.

Licensee/Administrator agree to conduct a follow up training regarding resident elopements.
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Based on interviews conducted and documentation reveiwed, the Licensee did not ensure that resident (R1) was not able to leave the facility on 8/28/22 and on 12/3/22, which posed an immediate health and safety risk to residents in care.
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Documentation to be provided to Dept by 5/26/23 that trainiing has been completed.
Request Denied
Type B
05/26/2023
Section Cited
CCR
87218
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87218 Theft and Loss (a) The licensee shall ensure an adequate theft and loss program as specified in Health and Safety Code Section 1569.153.
(1) The initial personal property inventory shall be completed by the licensee, and the resident, or the resident’s representative.(2) A licensee who fails to make reasonable efforts to safeguard resident property, shall reimburse a resident for or replace stolen or lost resident property at its current value. The licensee shall be presumed to have made reasonable efforts to safeguard resident property if there is clear and convincing evidence of efforts to meet each requirement specified in Section 1569.153. This requirement is not met as evidenced by:
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Licensee/Administrator agree to conduct training again on following the facility's Theft & Loss Policy, as listed in the Admission Agreement, per HSC 1569.152-1569.154.
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Based on interviews conducted and documentation reviewed, the Licensee did not ensure that each requirement was met per HSC 1569.153 to safeguard resident's paintings that were reported missing, which posed a personal rights violation to residents in care.
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Documentation to be provided to Dept by 5/26/23 that trainiing has been completed. Also provide updated Resident and Loss Record, LIC9060.
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: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 10
Control Number 25-AS-20230118165958
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
FACILITY NAME: SUNRISE OF ROCKLIN
FACILITY NUMBER: 315001968
VISIT DATE: 05/04/2023
NARRATIVE
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9099C(2).. Allegation: Staff did not provide authorized representative copies of resident's record.
Complaint alleges that R1's records were requested and not provided within (2) days as required.

Resident’s representative stated he did submit a written request for copies of R1's records in December 2022 and sent it certified mail, and 2 days later, he sent a second correspondence via certified mail, giving 30- day notice. RP stated the records request stated "All records related to (R1)" and has not received any records to date.

Administrator stated on 1/20/23 that RP asked verbally only for records during a phone call. MR stated that she did not tell RP the request had to be in writing and stated that RP and another individual on the phone call said they would be calling the corporate office.

While reviewing R1's file, on 5/4/23, LPA observed a letter from RP, dated 12/20/22, requesting a copy of R1's file, to include specific documents. The envelope was sent via certified mail and had been opened. LPA discussed the letter with Administrator who stated she had not previously seen the request but had seen the other envelope, also sent by certified mail, giving 30-day notice.

Based on information obtained, LPA finds the allegation to be SUBSTANTIATED- a finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.


Based on information obtained, LPA finds (3) allegations to be SUBSTANTIATED- a finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

Per California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies are being cited on the attached 9099-D pages

Exit interview was conducted with Administrator. A copy of this report and appeal rights were provided. Administrator's signature on these forms acknowledges receipt of these documents.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 10
Control Number 25-AS-20230118165958
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

FACILITY NAME: SUNRISE OF ROCKLIN
FACILITY NUMBER: 315001968
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/04/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
05/26/2023
Section Cited
CCR
87468.2(a)(19)
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87468.2 Additional Personal Rights of Residents in Privately Operated Facilities- (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights:(19) To have prompt access to review all of their records and to purchase photocopies of their records. Photocopied records shall be provided within two (2) business days and at a cost that does not exceed the community standard for photocopies.
This requirement is not met as evidenced by:
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Licensee/Administrator agree to provide copies of requested records by 5/26/23.

Submit documentation to the Department by 5/26/23.
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Based on documentation reviewed in resident's (R1) file, the Licensee did not ensure that records from (R1's) file were provided to R1's responsible person, within (2) days of receiving the written request on/around 12/22/22, which posed a personal rights violation to residents in care. . Letter was date stamped 12/20/22 by USPS.
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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: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
LIC9099 (FAS) - (06/04)
Page: 6 of 10
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/18/2023 and conducted by Evaluator Sabrina Calzada
COMPLAINT CONTROL NUMBER: 25-AS-20230118165958

FACILITY NAME:SUNRISE OF ROCKLINFACILITY NUMBER:
315001968
ADMINISTRATOR:MORADHASEL, ROUZBEHFACILITY TYPE:
740
ADDRESS:6100 SIERRA COLLEGE BLVDTELEPHONE:
(916) 632-3003
CITY:ROCKLINSTATE: CAZIP CODE:
95677
CAPACITY:82CENSUS: DATE:
05/04/2023
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Marianne Richardson, Administrator TIME COMPLETED:
06:45 PM
ALLEGATION(S):
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Staff administered resident medication without the authorized representative's consent resulting in hospitalization.
Staff overcharged resident while in care.
INVESTIGATION FINDINGS:
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During the investigation, LPA interviewed facility staff and resident's (R1) responsible person. LPA also reviewed MAR documentation for January 2023 as well as Power of Attorney Documentation and a letter signed by R1's physician on 1/26/22. The results are as follows:

The above allegation states that the facility did not follow resident's responsible person's request to not begin new order for medications for R1 until after R1 moved from the facility on/around 1/6/23.

The Department reviewed a letter from R1's physician, dated 1/26/22, stating that resident "is unable to make the best decisions for herself"... and is "deemed incapable of making her own decisions... and should be set up with a conservatorship". The Department reviewed resident's Durable Power of Attorney for Healthcare and Financial Management, signed on 1/31/22 by both R1 and resident's responsible person, and determined it to not be a valid document. due to it being signed after resident was "deemed incapable of making her own decisions"

cont on 9099AC(1)....

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 7 of 10
Control Number 25-AS-20230118165958
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
FACILITY NAME: SUNRISE OF ROCKLIN
FACILITY NUMBER: 315001968
VISIT DATE: 05/04/2023
NARRATIVE
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9099A-C(1). Resident's charting notes, dated 12/30/22, reflect a conversation with responsible person and a Med-Care Manager that resident's doctor just ordered new changes to R1's Seroquel order but resident will not start the new order yet since she will be moving in 2 weeks. Charting notes entered on 1/2/23 (17:33) document that another pharmacy delivered Donepezil and Buspirone to the facility and also faxed an order to taper off Seroquel. Notes indicate that the Wellness Nurse spoke to R1's responsible person and "he stated he doesn't want resident to start the medications at this time or make any changes with her medications since (R1) is moving out soon". Notes say responsible person is unsure how the other pharmacy got the orders from R1's primary care physician since he hasn't approved to start the medications yet.

LPA reviewed a new order for Seroquel, dated 1/1/23, to discontinue the previous order for Seroquel and to give the following medications:
Donepezil 10 mg (1/2 tablet daily for 4 weeks, then 1 tablet daily);
Buspirone 5 mg- take 1 tablet by mouth, 3 times/day
Seroquel 25 mg- decrease to 25 mg daily for 5 days then discontinue order. Order was signed by resident's nurse practitioner on 1/3/23 and faxed to the facility on 1/3/23 (1051).

MAR records for January 2023 show that R1 was administered Buspirone and Donepezil through 1/6/23, morning dosage. MAR shows Seroquel was administered, twice daily, under the prior order on 1/1/23 - 1/2/23 and for the morning dosage on 1/3/23. A second dosage of Seroquel 25 mg was administered on 1/3/23 and on 1/4/23, the dosage was dropped to once daily.

MAR shows the new order for Seroquel 25, once daily, was administered starting on 1/4/23 through 1/5/23. Resident moved out on 1/6/23. Based on documentation reviewed, the facility followed the physician's orders and administered medications as prescribed by the doctor . Resident was taken to the emergency room on 1/6/23 and was hospitalized until 1/8/23 for complaints of abdominal pain. Hospital medical records say resident was treated for colitis. It cannot be determined that because the facility followed physician orders with regard to the medication Seroquel, that resident was hospitalized.

Based on information obtained, LPA finds the allegation to be UNSUBSTANTIATED- A finding that a complaint allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.
cont on 9099A-C(2)....
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
LIC9099 (FAS) - (06/04)
Page: 8 of 10
Control Number 25-AS-20230118165958
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
FACILITY NAME: SUNRISE OF ROCKLIN
FACILITY NUMBER: 315001968
VISIT DATE: 05/04/2023
NARRATIVE
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9099A-C(2).. Allegation: Staff overcharged resident while in care. Complaint alleges that following the first elopement, resident's (R1) responsible person was informed that R1, would require a full-time, 24/7 caregiver to watch over her, but the facility did not inform him that he would be responsible for paying the sitter. On/around 12/16/22, resident/resident's responsible person was issued a bill for for the private sitter from 8/31/22 to 12/16/22.

Resident’s representative stated he was not told by the facility that he or resident would have to pay for the 1:1 supervision and and assumed it was included in the basic rent charge resident was paying. Responsible person asserted that he told the facility Administrator, he "refused to pay for 1:1 after the first AWOL" at the end of August 2022. Responsible person stated he didn't know how much the 1:1 supervision cost until December, on 12/16/22, when he received a bill, at which time he gave R1's 30-day notice.. RP stated he was not aware he was being charged for 1:1 until December when he received a bill.

Interviews with multiple staff managers, including the Administrator, Business Office Director, Assisted Living Coordinator and Memory Care Coordinator, confirmed that R1's responsible person was told that he would need to pay for resident's 1:1 care needed to prevent her from eloping from the facility again. Narrative charting notes, on 8/28/22 and 8/31/22, document conversations and phone calls attempts with responsible person to discuss responsible person obtaining a 1:1 care giver, 24/7 for resident. Specifically, notes entered on 8/31/22 by Assisted Living Coordinator, Elaina, that the facility is "waiting on 1:1 being set up by RP (responsible person)". Ombudsman stated in an email to LPA that responsible person was told he would have to pay for the 1:1 supervision.

Administrator stated there were initial discussions with R1's responsible person about the cost of a 1:1 caregiver, 24/7, but when follow up attempts were made by phone to discuss the discussion, the phone call would "always drop" with resident's responsible person stating he "didn't know what happened'". Administrator stated resident's responsible person has a "solid ballpark idea" of the cost a 1:1 caregiver, 24/7, would cost him. The Administrator stated the facility "stepped in because the responsible person was not following through" in obtaining a caregiver. Administrator stated a 1:1 caregiver was found through a new agency they had recently started working with for registry staff. Both the Administrator and Business Office Director confirmed that when a new vendor is used, there are billing delays in the system. Billing statements provided by the facility, dated 8/31/22, 9/30/22, 10/31/22 and 11/30/22, only show each monthly charge for basic services, medication and additional charges based on the resident’s service level. The 1:1 companion care, billed starting on 8/31/22 through 11/5/22, was not charged until the statement dated 12/31/22. The following monthly statement, dated 1/31/23, list charges for companion care for the period 11/6/22-12/31/22. cont on 9099A-C(3)...
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
LIC9099 (FAS) - (06/04)
Page: 9 of 10
Control Number 25-AS-20230118165958
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
FACILITY NAME: SUNRISE OF ROCKLIN
FACILITY NUMBER: 315001968
VISIT DATE: 05/04/2023
NARRATIVE
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9099A-C(3)..Based on information obtained, LPA finds the allegation to be UNSUBSTANTIATED- A finding that a complaint allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview with Nicole James, Director of Sales. Administrator, Marianne Richardson, attended by phone since she had to leave the facility before LPA was finished. with today's report.

Copy of report left at facility.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
LIC9099 (FAS) - (06/04)
Page: 10 of 10