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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700705
Report Date: 10/25/2023
Date Signed: 10/25/2023 05:28:42 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
10/19/2023 and conducted by Evaluator Sabrina Calzada
PUBLIC
COMPLAINT CONTROL NUMBER: 59-AS-20231019152340
FACILITY NAME:SUN OAK ASSISTED LIVINGFACILITY NUMBER:
342700705
ADMINISTRATOR:KEY, KAYEFACILITY TYPE:
740
ADDRESS:7241 CANELO HILLS DRIVETELEPHONE:
(916) 722-2800
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:78CENSUS: 31DATE:
10/25/2023
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Daniel Torgersen, Asst Administrator and Aida Ventoso, Care Coordinator TIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff do not ensure that hazardous materials are inaccessible to residents in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to open a complaint received anonymously on-line on 10/17/23. LPA met with Daniel Torgersen, Assistant Administrator, and explained purpose of inspection. LPA met with Aida Ventoso, Care Coordinator, later during the inspection. During today's inspection, LPA toured the Memory Care Unit, main kitchen and common areas of the facility.LPA also observed medications that are centrally stored in the medication room and reviewed all (8) residents' binders, specifically the physician's report. LPA also spoke with the Ombudsman regarding their inspection on 10/20/23 pertaining to the same allegations. The results of the investigation are as follows:

Allegation: Staff do not ensure that hazardous materials are inaccessible to residents in care.
The complaint alleges that memory care residents have access to cleaning supplies and toiletries due to no locks and lack of staff.

LPA and the Care Coordinator toured the common areas of the Memory Care Unit and (7) resident rooms that are currently occupied by (8) residents. In all rooms, LPA observed unlocked hygiene products, including, but not limited to, shampoo, body wash, lotion in both the sink area and shower area.
**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: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023
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 6
Control Number 59-AS-20231019152340
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: SUN OAK ASSISTED LIVING
FACILITY NUMBER: 342700705
VISIT DATE: 10/25/2023
NARRATIVE
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9099C-1... In the shared room, the Care Coordinator indicated the hygiene items were unlocked due to staff preparing to give one of the resident a shower. LPA observed a plastic, child lock to be the lock being used. Per residents' physician's reports, (R1) is allowed direct access to hygiene items; however, (R2) is not allowed direct access to hygiene items. Both residents were in the common area when LPA inspected.

LPA observed unlocked creme in the cabinet by the bathroom sink and inside the shower in (R3's) room. (R3) is not allowed access to personal hygiene items based on her physician's report.

LPA observed unlocked hygiene items in (R4's) room; however, (R4) is allowed direct access to personal hygiene items based on her physician's report. (R5) is not at risk for accessible unlocked hygiene items. LIC602 is dated 7/19/23. (R6) was observed to be sleeping at the time of the inspection. Care Coordinator confirmed (R6) is has a high cognitive awareness than other residents. LIC602 is dated 8/20/22 and indicates (R6) can have access to hygiene items. (R7) is under hospice care and was observed to be resting in bed. LPA observed unlocked hygiene items in the bathroom. (R7's) physician's report notes that (R7) cannot have access to specifically razors or sharp objects. LPA did not observe any razors or sharp objects in the room and Care Coordinator confirmed razors are not allowed in the Memory Care Unit. (R7's) physician's report was completed 7/13/23. LPA observed sanitizers and lotion to be unlocked in (R8's) room near the sink and shower. (R8's) physician's report indicates that she can have access to hygiene products. (R8's) physician's report was last updated on 3/10/22. The Care Coordinator stated (R8's) family is aware and has been trying to obtain an updated report.

LPA observed all toxins to be locked in the common areas, resident rooms and laundry room in the Memory Care Unit. The Ombudsman checked cabinets and drawers in the same areas, on 10/20/23, and observed all chemicals and cleaning supplies to be locked.

Based on observation and documentation, LPA finds the portion of the allegation relating to unlocked hygiene items 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, the following (1) citation is issued on the 9099-D page.

Exit interview. Copy of report and appeal rights provided.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 6
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
10/19/2023 and conducted by Evaluator Sabrina Calzada
PUBLIC
COMPLAINT CONTROL NUMBER: 59-AS-20231019152340

FACILITY NAME:SUN OAK ASSISTED LIVINGFACILITY NUMBER:
342700705
ADMINISTRATOR:KEY, KAYEFACILITY TYPE:
740
ADDRESS:7241 CANELO HILLS DRIVETELEPHONE:
(916) 722-2800
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:78CENSUS: 31DATE:
10/25/2023
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Daniel Torgersen, Asst Administrator and Aida Ventoso, Care Coordinator TIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Facility has pests.
Staff do not report incidents involving residents as required.
Staff are mismanaging resident(s) medication(s).
INVESTIGATION FINDINGS:
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LPA spoke with the Ombudsman following her inspection on 10/24/23 and was provided with the following information. The Ombudsman toured all areas of the facility on 10/20/23 and conducted an in-depth inspection of the main kitchen, cabinets, drawers, pantries, underneath counters, in the dish washer area, and spoke with the Kitchen manager. LPA also inspected all areas of the kitchen including near baseboard areas, inside pantries and near fresh produce. LPA did not observe any roaches when produce bins and other containers were moved slightly. Both the Ombudsma and LPA did not observe any roach droppings or live roaches in or near the kitchen.

LPA observed one roach that appeared to be dead inside a cabinet underneath the juice machine. One staff indicated that she saw roaches more a few months ago prior to the quarterly pest control treatment and recently saw one alive roach. The Dining Service Coordinator stated she has not seen any roaches, the kitchen is mopped and degreased every evening, and was informed by the pest control that any roaches
cont on 9099A-C-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: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 59-AS-20231019152340
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: SUN OAK ASSISTED LIVING
FACILITY NUMBER: 342700705
VISIT DATE: 10/25/2023
NARRATIVE
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9099A-C-1... seen outside the kitchen are coming from the rock-bed area outside the dining room doors. LPA did not observe live roaches or recent droppings that would indicate there is an infestation in the kitchen.
Based on information obtained, LPA Finds the allegation to be 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.

Allegation: Staff do not report incidents involving residents as required. Complaint alleges that the facility does not report medication errors or elopements.

LPA discussed the allegation with the Care Coordinator, Aida, and the Assistant Administrator, who indicated that the facility does regularly report as required, per Title 22. LPA reviewed Regulation 87211- Reporting Requirements during the discussion. LPA also requested to review incident reports recently submitted to the department. LPA was provided with copies of several reports, one of which included an AWOL incident. The Care Coordinator stated the prior Administrator advised staff to report any AWOL within 24 hours, instead of the required (7) days. LPA acknowledges that the facility regularly submits incident reports to the Department.

Based on information obtained, LPA Finds the allegation to be 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.

Allegation: Staff are mismanaging resident(s) medication(s). Complaint alleges that medications are pre-poured up to 5 days in advance.

The Care Coordinator stated that all medications are poured for Memory Care residents only up to 24 hours. At 12:30 pm, LPA observed pre-poured containers to be empty for the "am" and "Noon" dosages and to be filled for "pm" and "bedtime" dosages. The Ombudsman found that there were no medications left on the counter and no evidence that the Med-Tech staff "pre-load" any medication.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 59-AS-20231019152340
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: SUN OAK ASSISTED LIVING
FACILITY NUMBER: 342700705
VISIT DATE: 10/25/2023
NARRATIVE
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9099A-C-2...LPA reviewed the last medication audit report, dated 9/25/23, from an outside pharmacy.

The report lists under the comments section: Medications were prepared the previous day by another staff member as staff member being observed said she did not work the previous day. The report recommends that medications are not prepared until just prior to the medication pass time, stating many errors can occur when preparing medications too far in advance such as changes to medication orders and medication colors change based on the manufacturer.

The report notes that there was an increase, from last quarter, in blank areas or "holes" in the Medication Administration Record (MAR). Several common reasons are listed on the report with the most likely reason appearing to be from a Power Outage. Several recommendations were made to prevent these holes. Additionally, it was recommended to activate the Emergency MAR feature on at least one computer, and ideally on any computer used for the medication pass which would allow copies of the MAR to be saved automatically each day, in the event of a power outage or internet service goes down. The report notes that this concern was noted in the last health check report also and instructions provided on how to enable and use this feature.

The Department generally allows up to (24) hours to pre-pour medications. It is unclear if the medications poured the day before the audit was conducted were prepared more than (24) hours in advance.

Based on information obtained, LPA Finds the allegation to be 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. Copy of report left at the facility,
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 59-AS-20231019152340
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: SUN OAK ASSISTED LIVING
FACILITY NUMBER: 342700705
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/25/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/26/2023
Section Cited
CCR
87705(f)(1)
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87705 Care of Persons with Dementia
(f) The following shall be stored inaccessible to residents with dementia:

(1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). This requirement is not met as evidenced by:
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Administrator stated the items would removed today for (R2) and (R3). Locks to be installed within 24 hours in those resident rooms.

Photo documentation to be provided to CCLD by 10/26/23 by fax/email.
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Based on observation, the Licensee did not ensure that hygiene items were secured for residents (R2 and R3) in their rooms and bathroom, which posed an immediate health and safety risk to residents 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: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023
LIC9099 (FAS) - (06/04)
Page: 6 of 6