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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700705
Report Date: 06/10/2024
Date Signed: 06/10/2024 04:24:11 PM


Document Has Been Signed on 06/10/2024 04:24 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 LIVINGFACILITY NUMBER:
342700705
ADMINISTRATOR:SUMMERHAYS, CALEBFACILITY TYPE:
740
ADDRESS:7241 CANELO HILLS DRIVETELEPHONE:
(916) 722-2800
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:78CENSUS: 62DATE:
06/10/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:20 PM
MET WITH:Danny Torgersen, Assistant Administrator TIME COMPLETED:
04:25 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived earlier in the afternoon to conduct an unrelated inspection and met with Daniel Torgersen, Assistant Administrator, and Karen Padilla, Director of Nursing. While finishing the other inspection, the Assistant Administrator made LPA aware of a recent unrelated incident between staff member (S1) and resident (R1).

The incident involved (S1) withholding scheduled medications to (R1) on at least two separate occasions.(S1) admitted withholding medications on/around 5/31/24 and was terminated from working at the facility shortly thereafter. In addition to withholding medications, (S1) administered a medication later than the scheduled time, on at least one other occasion.

The Director of Nursing confirmed the medication name and dosage that was reportedly not administered. A detailed audit was conducted and no medications were found to be missing or to be in excess, and all medication documentation was initialed as being given as ordered.

The Assistant Administrator stated he would submit a completed incident report for these incidents, providing as much detail as possible.

There are no deficiencies issues in this report at this time.

Exit interview. Copy of report provided to the facility.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 06/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/10/2024
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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