342700705-2-1-2024-59-AS-SCAA-D22T6D-20240201132657

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 342700705
Report Date: 02/01/2024
Date Signed: 02/01/2024 01:27:11 PM

Document Has Been Signed on 02/01/2024 01:27 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

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
ADMINISTRATOR:	SUMMERHAYS, CALEB		FACILITY TYPE:	740
ADDRESS:	7241 CANELO HILLS DRIVE		TELEPHONE:	(916) 722-2800
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95610
CAPACITY:	78	CENSUS:	DATE:	02/01/2024
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Kaila Ventosa, Community Relations Director		TIME COMPLETED:	01:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a case management inspection to follow up on several incident reports submitted to the Department on 1/26/24. LPA met with Kaila Ventosa, Community Relations Director, and explained purpose of inspection. LPA was advised Daniel Torgersen, Assistant Administrator, was out of the building at the time of the inspection. LPA and the Community Relations Director discussed the following residents and related incident reports: Resident (R1) was sent to the emergency room on 1/25/24 for showing signs of weakness, diarrhea and not being able to transfer independently as normal. Resident was admitted due to a very high blood cell count, was discharged on 1/26/24 and was prescribed (7) days of the antibiotic, Cefplodoxime-Proxetil. Symptoms have subsided and the antibiotics will be finished 2/2/24. Resident (R2) was sent out on 1/22/24 at 1:23 pm after showing signs of aggressiveness and agitation towards staff. Resident returned later in the day with a med change to increase Citopram. Resident was again sent to the emergency room on 1/24/24, around 4:20 am, for being confused and showing aggression and agitation towards staff. Resident returned later in the evening, around 9:00 pm with a new order for Seroquel. Resident has not has any further incidents of aggression towards staff. Resident (R3) was sent to the emergency room on 1/25/24 after complaining of feeling tired, lethargic and had difficulty breathing. Resident returned to the community on 1/28/24 with (2) liters of oxygen and order for home health. Tests determined resident did not have a stroke or heart attack. Resident was sent out again on 2/1/24 due to complaining of chest pain. Charting notes indicate that resident has been using oxygen as ordered. A temporary care plan was created on 1/28/24 to show resident's change in condition with an increase in care needed in the areas of toileting, dressing and with transfers. Resident is able to use oxygen without any assistance. cont on 809C-1...

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2024

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

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 02/01/2024

NARRATIVE

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809C-1... Resident (R4) was sent to the emergency room on 1/18/24 due to slurring his words. Resident was admitted with a diagnosis of pneumonia and was prescribed a (5) day course of the antibiotic, amoxicillin, which was finished 1/30/24. Resident's roommate did not contract pneumonia .

Resident (R5) requested to be sent to the emergency room due to not having any insulin, after moving to the facility. Resident's previous facility sent vials instead of an insulin pen that resident is able to use. Resident returned on 1/24/24 after the facility called to ask for an update. Resident had inadvertently told the hospital the facility would not take him back and so new placement was being sought. Resident was sent back to the hospital on 1/24/24 around 6:00 pm due to very high blood sugar, resulting from food the resident ate in the hospital. Resident returned a few hours later and blood sugar levels have leveled out ever since.

Resident (R6) was sent to the emergency room on 1/21/24 for blood found in resident's catheter bag. Resident remains hospitalized for further testing and monitoring. The hospital is providing weekly updates to the community on resident's progress.

Resident (R7) had an unwitnessed fall on 1/19/24 around 9:00 am. Resident stated to staff he had slipped from his bed and hit his head on the corner of his bed. Resident was sent to the emergency room where multiple tests were performed. Resident was determined to have fractured his neck and will spend two weeks at a skilled nursing facility before returning to the community. LPA was told resident is not a fall risk and staff believes resident may have injured himself by not requesting assistance in the bathrooom.

It appears the facility took appropriate action in sending each resident out for further medical attention. There are no deficiencies cited in this report.

The facility was requested to update the second page of the incident report with information relating to the discharge of resident (R4) and resubmit the report to the Department. LPA also reminded the community to be sure to submit all incident reports to the Department within (7) days of the occurrence.

Exit interview with Care Coordinator, Aida Ventosa. Copy of report provided.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2024

LIC809 (FAS) - (06/04)

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