315001968-9-12-2022-25-AS-LMUZ-CJFR84-20220920124719

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 315001968
Report Date: 09/12/2022
Date Signed: 09/12/2022 11:17:54 AM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/13/2022 and conducted by Evaluator Talwinder Bains

COMPLAINT CONTROL NUMBER: 25-AS-20220413093321

FACILITY NAME:	SUNRISE OF ROCKLIN		FACILITY NUMBER:	315001968
ADMINISTRATOR:	MORADHASEL, ROUZBEH		FACILITY TYPE:	740
ADDRESS:	6100 SIERRA COLLEGE BLVD		TELEPHONE:	(916) 632-3003
CITY:	ROCKLIN	STATE: CA	ZIP CODE:	95677
CAPACITY:	82	CENSUS: 60	DATE:	09/12/2022
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Marianne Richardson, Executive Director		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Resident not provided medical care in a timely manner.
Resident is dehydrated.
Resident has lost a lot of weight.
There was no supervisor at the facility.
Facility administer wrong prescribed medication (ointment) to resident which belong to another resident.

INVESTIGATION FINDINGS:

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On 09/12/22, Licensing Program Analyst (LPA) Talwinder Bains conducted an unannounced complaint investigation visit to deliver the findings for the above allegations and met with Marianne Richardson, Executive Director. Prior to initiating the complaint visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. Upon arrival, completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA was screened with temperature at the facility.

The department conducted records review and extensive interviews.

**Report continued on LIC9099-C**

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder Bains	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022

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 7

Control Number 25-AS-20220413093321

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: SUNRISE OF ROCKLIN	FACILITY NUMBER: 315001968
	VISIT DATE: 09/12/2022

NARRATIVE

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Allegation- Resident not provided medical care in a timely manner.

The department conducted interviews regarding this allegation. Interviews indicated that staff were aware of R1’s need based on R1’s needs and service plan. A review of documentation and interviews conducted revealed that staff were following R1’s needs and service plan as documented. After R1 medical records review and file review, department also concluded that facility nursing staff did communicate with R1 doctor, family and other required agencies for any health concerns for R1. Facility also notified CCLD for R1’s health updates per department reporting protocol. Department concluded that facility did seek medical help for R1 in timely manner to address any health-related concerns for R1, therefore this allegation is UNFOUNDED . A finding that the allegations are unfounded means that the allegations are false, could not have happened, and/or is without a reasonable basis.

Allegation-Resident is dehydrated.

The department conducted interviews and record review to investigate above allegation. Department conducted several interviews with facility staff and residents to investigate this allegation. Upon R1s records review, it was mentioned on when R1 was sent out to hospital by facility on 04/13/22 after a fall incident however R1 was diagnosed with severe UTI(Urinary Tract Infection) and dehydration in hospital (dehydration is one of the common symptoms related to UTI for seniors). Upon R1 records review, department found out that R1 was taking antibiotics for UTI prior to 04/13/22 and was tolerating it well as shown in facility’s documentation. Based on the records review, it has not determined that R1 was dehydrated due to facility’s care or neglect, therefore this allegation is UNFOUNDED . A finding that the allegations are unfounded means that the allegations are false, could not have happened, and/or is without a reasonable basis.

**Report continued on LIC9099-C**

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder Bains	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 7

Control Number 25-AS-20220413093321

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: SUNRISE OF ROCKLIN	FACILITY NUMBER: 315001968
	VISIT DATE: 09/12/2022

NARRATIVE

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Allegation-Resident has lost a lot of weight.

The department conducted interviews and record review to investigate above allegation. Department conducted several interviews with facility staff and residents to investigate this allegation. During interviews, facility residents stated that facility staff check resident’s weight based on physician orders and/or if there is an indicated need of a specific resident to have their weight taken. Department reviewed weight records for R1. R1 had weight recorded as 164 lbs on 11/11/19 at the time of admission. R1s weight was recorded as 160 lbs in April 2022. It has been found out that R1s weight was checked monthly per orders and there was no indication of any significant weight loss, therefore this allegation is UNFOUNDED . A finding that the allegations are unfounded means that the allegations are false, could not have happened, and/or is without a reasonable basis.

Allegation-There was no supervisor at the facility.

The department conducted interviews, facility observation and record review to investigate above allegation. Department conducted several interviews with facility staff and residents to investigate this allegation. During staff interviews conducted on 05/12/22, facility staff stated that managers and supervisors are available to address any questions/concerns from residents, staff or resident’s family. During residents’ interviews conducted on 08/29/22, facility residents stated that there are no issues if they wish to speak to any managers/supervisors to address any concerns. A review of staff schedule indicated that there is a manager available during all shifts. Based on this information, department has concluded that this allegation is UNFOUNDED . A finding that the allegations are unfounded means that the allegations are false, could not have happened, and/or is without a reasonable basis.

**Report continued on LIC9099-C**

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder Bains	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 7

Control Number 25-AS-20220413093321

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: SUNRISE OF ROCKLIN	FACILITY NUMBER: 315001968
	VISIT DATE: 09/12/2022

NARRATIVE

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Allegation-
Facility administer wrong prescribed medication (ointment) to resident which belong to another resident.

The department conducted interviews and record review to investigate above allegation. Department conducted several interviews with facility staff and residents to investigate this allegation. During investigation, Facility staff and residents stated that there are no concern/issues with medication administration. Facility staff also denied that facility administered any wrong medication to any residents. Facility residents verbalized that their medications are administered mostly on-time with no issues. Based on this, department has concluded that this allegation is UNFOUNDED . A finding that the allegations are unfounded means that the allegations are false, could not have happened, and/or is without a reasonable basis.

Exit interview was conducted with Marianne and a copy of this report was provided to the facility. No deficiencies cited. The signature of Marianne on these forms acknowledges receipt of these documents.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder Bains	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022

LIC9099 (FAS) - (06/04)

Page: 4 of 7

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/13/2022 and conducted by Evaluator Talwinder Bains

COMPLAINT CONTROL NUMBER: 25-AS-20220413093321

FACILITY NAME:	SUNRISE OF ROCKLIN		FACILITY NUMBER:	315001968
ADMINISTRATOR:	MORADHASEL, ROUZBEH		FACILITY TYPE:	740
ADDRESS:	6100 SIERRA COLLEGE BLVD		TELEPHONE:	(916) 632-3003
CITY:	ROCKLIN	STATE: CA	ZIP CODE:	95677
CAPACITY:	82	CENSUS: 60	DATE:	09/12/2022
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Marianne Richardson, Executive Director		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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9

Resident was given alcohol that could have caused serious health issues.
Staff is not providing care of resident agreed to in the level of care.
Staff are not able to meet the needs of the residents.
Staff is not assisting resident with hygiene.

INVESTIGATION FINDINGS:

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Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder Bains	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 5 of 7

Control Number 25-AS-20220413093321

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: SUNRISE OF ROCKLIN	FACILITY NUMBER: 315001968
	VISIT DATE: 09/12/2022

NARRATIVE

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Allegation-Resident was given alcohol that could have caused serious health issues.

The department conducted interviews and record review to investigate above allegation. Department conducted several interviews with facility staff and residents to investigate this allegation. During facility staff and residents’ interviews conducted on 05/12/22 and 08/29/22, staff and residents stated that residents can request wine at the facility. During staff interviews and R1s record review, it has been found out that R1 use to enjoy red wine with another resident during dinner time but according to family, R1 did not like wine. Based on R1’s medication documentation, there were no documented medical reasons that indicated R1 was unable to consume alcohol and/or that R1’s consumption of alcohol would impact R1’s medical conditions. Department has concluded that there was a possibility that R1 did order wine with meals. There was no documentation in facility notes regarding any ill effects on R1s health by consuming wine, Therefore, the above allegation is found 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.

Allegation-Staff is not providing care of resident agreed to in the level of care agreement.

The department conducted interviews, facility observation and record review to investigate above allegation. During interviews with facility staff and residents, it has been discovered that facility is providing appropriate care to the residents per their needs. During residents’ interview on 08/29/22, residents stated that facility has enough staff and their care needs are met. During staff interviews on 05/12/22, staff stated that there are enough staff to work at the facility to meet resident’s care needs. During record review for R1, records indicated that facility did provide all required care and assistance to meet R1s needs per R1’s needs and service plan. During department visits on 04/19/22 and 08/29/22, department observed that residents appeared to be well groomed and in good care ,therefore, the above allegation is found 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.

**Report continued on LIC9099-C**

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder Bains	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022

LIC9099 (FAS) - (06/04)

Page: 6 of 7

Control Number 25-AS-20220413093321

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: SUNRISE OF ROCKLIN	FACILITY NUMBER: 315001968
	VISIT DATE: 09/12/2022

NARRATIVE

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Allegation-Staff are not able to meet the needs of the residents.

The department conducted interviews, facility observation and record review to investigate above allegation. During interviews with facility staff and residents, facility is providing appropriate care to the residents according to resident’s needs and service plans. During residents’ interview on 08/29/22, residents stated that facility has enough staff and their care needs are met. During staff interviews on 05/12/22, staff stated that there are enough staff to work at the facility to meet resident’s care needs. During record review for R1, records indicated that facility did provide all required staffing and assistance to meet R1s care needs. During department visits on 04/19/22 and 08/29/22, department observed that residents appeared to be well groomed and in good care, therefore, the above allegation is found 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.

Allegation- Staff is not assisting resident with hygiene.

The department conducted interviews, facility observation and record review to investigate above allegation. During interviews with facility staff and residents, facility is providing appropriate care to the residents according to resident’s needs and service plans. During residents’ interview on 08/29/22, residents stated that facility has enough staff and their care needs are met. During staff interviews on 05/12/22, staff stated that there are enough staff to work at the facility to meet resident’s care needs. During record review for R1, records indicated that facility did provide all required staffing and assistance to meet R1s care needs. During department visits on 04/19/22 and 08/29/22, department observed that residents appeared to be well groomed and in good care, therefore, the above allegation is found 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 was conducted with Marianne and a copy of this report was provided to the facility. No deficiencies cited. The signature of Marianne on these forms acknowledges receipt of these documents.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder Bains	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022

LIC9099 (FAS) - (06/04)

Page: 7 of 7