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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 315920051
Report Date: 11/19/2024
Date Signed: 11/19/2024 05:07:51 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
09/24/2024 and conducted by Evaluator Kevin Mknelly
COMPLAINT CONTROL NUMBER: 59-AS-20240924145842
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:
11/19/2024
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Carol PickardTIME COMPLETED:
05:15 PM
ALLEGATION(S):
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Staff did not adequately monitor resident’s oxygen administration.
INVESTIGATION FINDINGS:
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On 11/19/24, Licensing Program Analyst (LPA) Kevin Mknelly spoke with Executive Director, 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.

Staff did not adequately monitor resident’s oxygen administration- Records review R1 is diagnosed with chronic respiratory failure, requires oxygen, edema, fluid restrictions and mild cognitive impairment. R1 can follow instructions and is able to communicate needs. R1 is ambulatory and has escort services identified due to fall risk.
Interviews found R1’s Services Plan identifies that R1 has a low salt diet and recommended fluid restriction, R1 is to be escorted to and from meals and events and that staff will observe/ maintain/ report safe environment for oxygen and will evaluate needs of oxygen management.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024
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 5
Control Number 59-AS-20240924145842
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: 11/19/2024
NARRATIVE
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Documentation by the facility that escorts were provided to or refused by R1 were not available.
Interviews found that R1 would at times call for and accept escorts and at other times R1 would not.
Interviews of visitors for R1 found that R1 was found at times to not be using oxygen as recommended.
Interviews also found that there were not clear procedures in place to ensure that, even when R1 left an area not having asked for escort, R1 was then located and oxygen assistance was offered.

Therefore, there were times where R1 was not monitored as agreed to in the care plan which resulted in R1 not using oxygen as prescribed. The incidents observed did not result in R1 needing medical assistance for oxygen.

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. (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: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 59-AS-20240924145842
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: 11/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/10/2024
Section Cited
CCR
87618(b)(1)
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Oxygen Administration -(b) In addition to Section 87611(b), the licensee shall be responsible for the following: (1) Monitoring of the resident's ongoing ability to operate the equipment in accordance with the physician's orders. This requirement was not met based on records and interviews resulting n
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Licensee will submit a plan for insuring that residents with oxygen are monitored in their movements within the facility and that oxygen operations are available as prescribed by the POC date of 12/10/24.
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potential risk to the 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: 11/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
09/24/2024 and conducted by Evaluator Kevin Mknelly
COMPLAINT CONTROL NUMBER: 59-AS-20240924145842

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: DATE:
11/19/2024
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Carol PickardTIME COMPLETED:
05:15 PM
ALLEGATION(S):
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Staff did not ensure resident’s room was cleaned.
Staff did not seek timely medical attention for resident.
INVESTIGATION FINDINGS:
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On 11/19/24 Licensing Program Analyst (LPA) Kevin Mknelly conducted an unannounced complaint investigation visit to deliver the findings for the above allegations and met withthe program's Administrator.
LPA conducted records review and extensive interviews.
LPA is unable to find and or meet the preponderance, per policy.

Staff did not ensure resident’s room was cleaned- Statements made were that there are at times R1's room needed housekeeping between scheduled weekly housekeeping. One of the issues reported that there was blood on the lightswitch in R1's bathroom. R1 stated that they are satisfied with the services they receive. R1 was noted to have has skin tears that have bled. R1 stated they received first aid when requested. LPA observationR1's room on three occasions. On one occasion there were spots that appeared to be blood on the bathroom floor. R1 was unsure when that might have happened. On two other occasions R1 had been cleaned by housekeepers. LPA advised that facility staff be trained to watch for unreported biohazards and report incidents for timely clean-up.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 59-AS-20240924145842
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: 11/19/2024
NARRATIVE
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Staff did not seek timely medical attention for resident- Statements made found that R1 received medical care at times when visitors insisted but R1 did not feel it was necessary. Staff were following written physician instruction for when medical care should be sought. During the course of this investigation, R1's PCP has provided further guidance. LPA advised that when R1 returns from hospitalization that clear guidance and communication is in place for the monitoring and responses to R1's medical conditions.
During this investigation, R1 sustained a fall with injury. R1 had not requested assistance in getting out of bed, slipped and fell, and staff called for emergency services. LPA inspected the site of the fall after carpet cleaning had been done and did not find anything to have contributed to R1's fall.


As a result of this investigation, LPA finds allegation to be (US)Unsubstantiated - A finding that the complaint 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 administrator.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5