342700705-5-9-2024-59-AS-MSEY-D5ARQU-20240515131408

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700705
Report Date: 05/09/2024
Date Signed: 05/09/2024 06:08:08 PM

Unsubstantiated

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
04/05/2024 and conducted by Evaluator Sabrina Calzada

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20240405163236

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: 49	DATE:	05/09/2024
		UNANNOUNCED	TIME BEGAN:	01:05 PM
MET WITH:	Danny Torgersen, Administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff do not distribute residents' medications as prescribed
Licensee does not provide staff with required training prior to providing resident care
Staff do not report incidents to the appropriate parties
Staff force residents to take medications
Licensee does not provide residents with appraisals
Licensee does not ensure that staff are in good health for employment at the facility

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to open a complaint received on 4/5/2024. LPA met with Daniel Torgersen, Assistant Administrator, and explained purpose of inspection. Administrator stated he was leaving the building for an appointment and authorized the Director of Admission or Director of Nursing to sign today's report.

During today's inspection, LPA interviewed (4) additional staff in the Memory Care Unit and the Director of Nursing, reviewed training records for (6) MCU staff, reviewed ordered medications for (2) residents, and reviewed resident files for (3) MCU residents.

During the investigation, LPA interviewed additional MCU staff and reviewed (5) staff files for newly hired staff. The results of the investigation are as follows:

cont on 9099C-1...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024

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 4

Control Number 59-AS-20240405163236

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: 05/09/2024

NARRATIVE

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9099C-1.. Allegation: Staff do not distribute residents' medications as prescribed. Allegation states that facility is understaffed and meds are not distributed as prescribed and that Resident (R1) was not distributed seizure medication for over seven unspecified dates.

Resident (R1) moved to the facility on 2/1/24 and had a completed physician's report from the skilled nursing doctor. The Director of Nursing provided charting notes for R1 that on 3/7/24, her Keppra (or Levetiracetam 500mg) medication was suspended. LPA reviewed a fax notification that a 30-day supply was filled on 3/8/24. Charting notes state that on 4/1/24, the physician kept rescheduling the in-person appointment, so resident was sent out by non-emergency transport to the ER to get the prescription refilled. On 4/4/24, the doctor cancelled R1's appointment for that same day (4:00 pm) and rescheduled it for 7/2/24 (2:40 pm). Resident was sent out again on 5/1/24 to obtain another 30-day supply of Keppra.

Since Keppra is a controlled medication, another 30-day supply would not have been filled on 4/1/24 and again on 5/1/24. Staff interviews found that it was not clear that (R1) had missed any medication and only takes (2) total. LPA reviewed medication orders for (2) additional MCU residents and found medications are being given as ordered.

Based on information obtained, LPA Finds the allegation to be UNSUBSTANTIATED-

Allegation: Licensee does not provide staff with required training prior to providing resident care. The allegation states staff do not receive required training prior to providing resident care. There are no specific staff names provided in the allegation.

LPA reviewed training records for (8) staff who work in MCU. All records show that staff is completing both initial and ongoing training, as required. Multiple staff Interviews confirmed that staff is regularly completing training on-line, from an approved vendor, as well as from in-person training.

Based on information obtained, LPA Finds the allegation to be UNSUBSTANTIATED-

cont on 9099C-2...

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024

LIC9099 (FAS) - (06/04)

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Control Number 59-AS-20240405163236

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: 05/09/2024

NARRATIVE

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90099C-2... Allegation: Staff do not report incidents to the appropriate parties. The allegation states that staff do not report incidents occurring at the facility to the appropriate parties.

Multiple staff interviews conducted indicated that care staff will report to a Med-Tech or other lead staff if there has been an incident and either the care giver staff will complete the incident report or the Med-Tech staff will. Staff were interviewed who work on the "am" and "pm" shifts.

Based on information obtained, LPA Finds the allegation to be UNSUBSTANTIATED-

Allegation: Staff force residents to take medications. The allegation states staff will force residents in memory care to take their medications by crushing and hiding the medications into food. No specific names of staff or residents were provided.

All interviews conducted indicated that staff do not force residents to take any medications and only a few residents, who are under hospice care, have a order for crushed medications. LPA observed a Med-Tech staff give a resident medication during today's inspection and advised the resident the drink contained medication. Staff stated that any crushed medications will be placed in applesauce or pudding as ordered.

Based on information obtained, LPA Finds the allegation to be UNSUBSTANTIATED-

Allegation: Licensee does not provide residents with appraisals. The allegation states that residents are admitted into the facility without prior receiving assessments or receiving their medications.

LPA reviewed (5) resident files in MCU. (3) of the (5) files were for newly admitted residents. All files had a pre-appraisal that had been completed. The portion of the allegation referring to medication is for resident (R1). This was determined to be unsubstantiated also in this report.

Based on information obtained, LPA Finds the allegation to be UNSUBSTANTIATED-

cont on 9099C-3...

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 59-AS-20240405163236

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: 05/09/2024

NARRATIVE

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9099C-3...Allegation: Licensee does not ensure that staff are in good health for employment at the facility. The allegation states that there are staff that have worked at the facility for a few months however, the staff do not medical clearance. There were no specific staff names provided.

LPA reviewed (5) staff files on 4/8/24 and found all staff had a completed LIC503 with confirmation of a negative TB test on file. Revenue Cycle Manager stated on 4/8/24 “all staff has to get the 503 and TB test” before they can begin working. Multiple staff who were interviewed stated that they completed both a physical exam and a TB test prior to beginning their employment.

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 Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024

LIC9099 (FAS) - (06/04)

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