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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 315920051
Report Date: 10/15/2024
Date Signed: 10/15/2024 04:44:48 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, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/11/2024 and conducted by Evaluator Kevin Mknelly
COMPLAINT CONTROL NUMBER: 59-AS-20240911170931
FACILITY NAME:SONRISA SENIOR LIVINGFACILITY NUMBER:
315920051
ADMINISTRATOR:PICKARD, CAROLFACILITY TYPE:
740
ADDRESS:1031 ROSEVILLE PKWYTELEPHONE:
(279) 213-0047
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY:199CENSUS: 115DATE:
10/15/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:TIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff did not administer medication(s) to resident as prescribed.
Staff are mismanaging residents' medications.
INVESTIGATION FINDINGS:
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On 10/15/24, Licensing Program Analyst (LPA) Kevin Mknelly spoke to ED Carol Pickard, to deliver complaint findings for the above allegation.

LPA reviewed resident records, facility records and conducted extensive interviews.
LPA finds that the allegations cited above are substantiated.

Records and statements supported that on 9/9/24, R1 was given medications by med tech S1 that contained a half tab of a medication that did not belong to R1. S1's explanation of how the medication mix up happened were not credible. The error was caught by a family member present. R1 did not take the wrong medication that was dispensed to them. Additionally, R1 was to receive a medication that is to be administered before and seperate from other medications. Records and statements showed that upon admission R1 took a 7 AM medication. With an update to medication administration records (MAR) that same medication was then combined with others at 8 AM.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024
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 3
Control Number 59-AS-20240911170931
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SONRISA SENIOR LIVING
FACILITY NUMBER: 315920051
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/16/2024
Section Cited
CCR
87465(a)(4)
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Incidental Medical and Dental Care (a)(4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met based on statements and records which found an incident of a resident being handed another's medication and an
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Licensee will conduct and audit of all current medications and record the results of the audit to include refill numbers and next refill dates of all medications. Licensee will then submit a plan for periodic audits of medications.
By 10/16/24, licensee will submit the plan
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incident of a missed meication.
This posed an immediate risk to residents.
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and timeline in which the audit will be conducted and the plan to be submitted (with the plan date to be no later than 11/12/24).
Type B
11/29/2024
Section Cited
CCR
87465(h)(5)
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Incidental Medical and Dental Care (h)(5) Each resident's medication shall be stored in its originally received container. This requirement was not met based on statements that found medication was accepted into central storage and that those medications were no longer in their
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Licensee will submit proof of retraining for staff not accepting medications out of their original container and for correct recording of centrally stored medications by the POC date of 11/29/24.
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original container. This posed a potential risk to resident.
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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.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 59-AS-20240911170931
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: SONRISA SENIOR LIVING
FACILITY NUMBER: 315920051
VISIT DATE: 10/15/2024
NARRATIVE
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During this investigation, an additional medication issue was found. On 10/11/24, R2's family was notified of two medications that are due for refills. Due to the short notice weekend alert and some pharmacy related issues, R2 missed a dose of two medications. Furthermore, family provided and the staff accepted medications into the med room that were not in prescription bottles not logged into centrally stored medication. All medications for R2 have since been filled and R2 was unharmed. Centrally stored medication records for the two missed medications for R2 did not record the number of refills available for the medications.

As a result of this investigation, LPA finds allegation to be (S) Substantiated - A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. The following deficiencies were cited on 9099-D, per Title 22 Regulations, Division 6. (A)This poses an immediate Health and Safety risk to clients/residents in care. (B) This poses a potential Health and Safety risk, or personal rights violation, to clients/residents in care.

Report reviewed with Carol Pickard . Copy of this report and appeal rights provided.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024
LIC9099 (FAS) - (06/04)
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