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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336403028
Report Date: 05/04/2023
Date Signed: 05/04/2023 11:43:16 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/04/2020 and conducted by Evaluator Rayshaun Nickolas
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20200504123240
FACILITY NAME:SUNRISE AT CANYON CRESTFACILITY NUMBER:
336403028
ADMINISTRATOR:SEGURA, HEATHERFACILITY TYPE:
740
ADDRESS:5265 CHAPALA DRTELEPHONE:
(951) 686-6075
CITY:RIVERSIDESTATE: CAZIP CODE:
92507
CAPACITY:88CENSUS: 66DATE:
05/04/2023
UNANNOUNCEDTIME BEGAN:
11:07 AM
MET WITH:Heather Segura, Executive Director TIME COMPLETED:
11:50 AM
ALLEGATION(S):
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Resident sustained multiple fractures while in care.
Staff caused resident to fall resulting in an injury .
Staff failed to respond to residents alerts in a timely manner.
Staff mishandled resident's medication.
Staff failed to assist resident with toileting needs .
Staff failed to ensure residents were properly fed while in care

INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rayshaun Nickolas visited the facility unannounced to deliver the finding on the above allegations. LPA met with Executive Director Heather Segura and explained the purpose of the visit. These allegations were investigated by department staff. LPA Nickolas reviewed the facility files and conducted an additional interview with a facility staff member.

On May 12, 2020, due to COVID-19 protocols, LPA Shaunte Henry initiated the ten-day telephone complaint investigation into the alleged allegation that "Resident sustained multiple fractures while in care”.

The allegation alleged that resident # 1 (R1) sustained multiple fractures while in care due to facility staff neglect & lack of care and supervision. Department staff interview of facility staff members revealed that R1 was receiving physical therapy throughout the years at the facility. Physical therapy was recommended to build R1's strength, and as R1's strength improved, R1 would instead do things independently than ask for assistance
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Rayshaun NickolasTELEPHONE: (951) 255-9516
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 7
Control Number 18-AS-20200504123240
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA
FACILITY NAME: SUNRISE AT CANYON CREST
FACILITY NUMBER: 336403028
VISIT DATE: 05/04/2023
NARRATIVE
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The interview of facility staff members revealed that a few of the falls R1 had throughout the years were due to them doing things independently and not asking for help. The interview of facility staff members revealed that R1 resided in assisted living and did not require additional room checks. Assisted living residents are checked by their caregiver every two (2) hours unless a pendant or pull cord is activated. Department staff interview with R1 revealed that their first fall at the facility resulting in a fracture, was their fault because they were walking too fast while using their walker. R1 stated that they could not get off the floor on the second fall (which also resulted in a fracture). R1 could not provide the date of that fall, nor did R1 remember what they were doing when they fell. However, when asked if they called for assistance, R1 responded, "they did not need to because, at that time, they did things on their own". Department staff file review revealed that R1 received emergency and continuous medical care until they recovered from their injuries. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation.

Allegation #2 “Staff caused resident to fall resulting in an injury”. The allegation alleged that sometime in February 2020, resident # 1 (R1) returned to their room from lunch and used their walker with staff # 3 (S3) as an escort. The allegation alleged that R1 asked S3 not to let them fall because they felt unsteady. S3 let go of R1 to open the door, and R1 fell. Department staff interview with the reporting party (RP) revealed that R1 sustained a cut on their left knee and some soreness. Department staff interview with R1 revealed that S3 let go of them for a second, and they went down. R1 was unable to provide further details about this fall. Department staff interview with S3 revealed that on February 18, 2020, S3 was escorting R1 back to their room from lunch. S3 stated that R1 was using their walker, and when they got to their room, R1 stated they felt dizzy and tired. S3 described R1 as falling as their head and body tilted to one side. S3 stated they responded immediately, placed their arm around R1 as if hugging R1, and guided R1 down to the floor. S3 stated that R1 did not hit the floor because they could lay them down. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation.

Allegation # 3 “Staff failed to respond to residents’ alerts in a timely manner”. The allegation alleged that on April 11, 2017, R1 pushed their call button and waited for over 15 minutes for assistance. LPA Nickolas’ review of the facility log report on April 11, 2017, revealed that R1 activated their call button nine (9) times, and the facility staff responded in less than 15 minutes seven (7) out of (9) times. Two (2) times, facility staff responded long than 15 minutes; facility staff responded in 18 minutes at 3:01 p.m. and 16 minutes at 8:35 p.m.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Rayshaun NickolasTELEPHONE: (951) 255-9516
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: 6 of 7
Control Number 18-AS-20200504123240
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA
FACILITY NAME: SUNRISE AT CANYON CREST
FACILITY NUMBER: 336403028
VISIT DATE: 05/04/2023
NARRATIVE
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The allegation alleged that on April 9, 2020, R1 was left unattended in the bathroom for over 20 minutes. The allegation alleged that R1 pressed their call button several times. LPA Nickolas’ review of August 9, 2020, facility log report revealed that R1’s call button was activated three (3) times. The facility staff responded in two (2) minutes the first time the call button was activated on April 9, 2020. One (1) minute the second time the call button was activated on April 9, 2020, and eight (8) minutes the third time the call button was activated on April 9, 2020. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation.

Allegation # 4 “Staff mishandled resident’s medication”. The RP alleged that the facility misplaced R1’s medication and could not find it until two (2) days later. LPA Nickolas’ reviewed R1’s Medication Administration Records (MARs), which revealed that R1’s medication was administered per the physician’s orders. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation.

Allegation #5 “Staff failed to assist resident with toileting needs” The allegation alleged that on July 29, 2017, R1 was taken to the restroom and sat on the toilet after pushing their call button for 35 to 40 minutes for the facility staff to return to assist them. LPA Nickolas’ reviewed the facility log report on July 29, 2017 and revealed that staff responded to R1’s call button in less than 10 minutes. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation.

Allegation #6 “Staff failed to ensure residents were properly fed while in care”. The allegation alleged that on February 28, 2018, R1 did not receive breakfast and pushed their call button to inquire. Facility staff arrived, and R1 reported they missed breakfast, and the facility staff left and never returned. The allegation alleged that on March 19, 2020, R1 pushed their call button to report they did not get lunch. When unknown facility staff arrived, and R1 informed them that they did not receive lunch, R1 was advised that lunch was over. The unknown facility staff offered R1 fruit but did not bring R1 the fruit requested. LPA Nickolas’ interview with staff # 4 (S4) revealed that if a client cannot make dining services, the meal is held for them unless the client declines to eat. However, facility staff will also provide food to clients in care whenever a client announces they are hungry. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation.

A finding of Unsubstantiated means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted and copy of this report was provided.

SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Rayshaun NickolasTELEPHONE: (951) 255-9516
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: 5 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/04/2020 and conducted by Evaluator Rayshaun Nickolas
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20200504123240

FACILITY NAME:SUNRISE AT CANYON CRESTFACILITY NUMBER:
336403028
ADMINISTRATOR:SEGURA, HEATHERFACILITY TYPE:
740
ADDRESS:5265 CHAPALA DRTELEPHONE:
(951) 686-6075
CITY:RIVERSIDESTATE: CAZIP CODE:
92507
CAPACITY:88CENSUS: DATE:
05/04/2023
UNANNOUNCEDTIME BEGAN:
11:07 AM
MET WITH:TIME COMPLETED:
11:50 AM
ALLEGATION(S):
1
2
3
4
5
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8
9
Resident sustained multiple falls while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rayshaun Nickolas visited the facility unannounced to deliver the finding on the above allegations. LPA met with Executive Director Heather Segura and explained the purpose of the visit. This allegation was investigated by department staff.

The allegation alleged that resident #1 (R1) fell on April 24, 2017, and R1 did not sustain injury. The allegation alleged that, on an unknown date, staff # 1 (S1) cleaned R1’s bathroom, took the riser off the toilet to clean it, and forgot to place it back on the toilet seat. The RP further states that staff #2 (S2) went to take R1 to the restroom. S2 failed to notice that the riser was not on the toilet, and R1 fell very hard on the toilet. Department staff interview with S1 revealed that S1 admitted they forgot to place the riser on the toilet seat that day, but it was not intentional.



Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Rayshaun NickolasTELEPHONE: (951) 255-9516
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: 2 of 7
Control Number 18-AS-20200504123240
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA
FACILITY NAME: SUNRISE AT CANYON CREST
FACILITY NUMBER: 336403028
VISIT DATE: 05/04/2023
NARRATIVE
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Based on the evidence gathered during the investigation, the above allegation is Substantiated. A finding that the complaint is Substantiated means that the allegation(s) is valid because the preponderance of the evidence standard has been met.

An exit interview was conducted where a copy of this report (LIC 9099), LIC 9099D, and appeal rights were discussed and provided.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Rayshaun NickolasTELEPHONE: (951) 255-9516
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 7
Control Number 18-AS-20200504123240
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA

FACILITY NAME: SUNRISE AT CANYON CREST
FACILITY NUMBER: 336403028
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/04/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/19/2023
Section Cited
CCR
87411(a)
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87411 Personnel Requirements-General (a)

Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs...
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The licensee shall provide full training to all staff on proper use of asisted devices, and proper placement before resident care. The Licensee shall submit training records to the Regional Office (RO) by the POC due date.
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This requirement was not met as evidenced by:

Based on interviews, the facility staff did not ensure the riser was placed on the toilet to prevent R1 from falling, which is a potential health, safety, personal rights violation to persons in care.
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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: Karen ClemonsTELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Rayshaun NickolasTELEPHONE: (951) 255-9516
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: 4 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/04/2020 and conducted by Evaluator Rayshaun Nickolas
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20200504123240

FACILITY NAME:SUNRISE AT CANYON CRESTFACILITY NUMBER:
336403028
ADMINISTRATOR:SEGURA, HEATHERFACILITY TYPE:
740
ADDRESS:5265 CHAPALA DRTELEPHONE:
(951) 686-6075
CITY:RIVERSIDESTATE: CAZIP CODE:
92507
CAPACITY:88CENSUS: DATE:
05/04/2023
UNANNOUNCEDTIME BEGAN:
11:07 AM
MET WITH:TIME COMPLETED:
11:50 AM
ALLEGATION(S):
1
2
3
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Resident is left being soiled multiple times.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rayshaun Nickolas visited the facility unannounced to deliver the finding on the above allegation. LPA met with Executive Director Heather Segura and explained the purpose of the visit. . The investigation consisted of file reviews and interviews with relevant parties.

The allegation alleges that “Resident is left being soiled multiple times”. The reporting party (RP) alleged that on September 7, 2017, R1 pushed their call button for bathroom assistance, and no one came to help. As a result, R1 sat in a dirty diaper for over 40 minutes. LPA Nickolas' review of the facility log report on September 7, 2017, reviewed R1’s did not activate their call button on that day.

This agency has investigated the complaint allegations. We have found that the complaint was unfounded meaning that the allegations were false, could not have happened and/or are without a reasonable basis. We have therefore dismissed the complaint.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Rayshaun NickolasTELEPHONE: (951) 255-9516
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 7