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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700705
Report Date: 06/27/2024
Date Signed: 06/27/2024 03:18:19 PM


Document Has Been Signed on 06/27/2024 03:18 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: 65DATE:
06/27/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Danny Torgersen, Assistant Administrator TIME COMPLETED:
03:20 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived earlier in the afternoon to conduct a case management inspection related to resident (R1). LPA initially met Karen Padilla, Director of Nursing and stated the reason for today's inspection. LPA met with Daniel Torgersen, Assistant Administrator, later during the inspection.

The Department received information in the month of June, 2024, reporting that resident (R1) was not receiving regular showers. LPA reviewed case notes, dated 6/5/24, stating that (R1) had been visited in the morning and reported she was not receiving showers or having her hair washed or combed. The health care visitor observed a "heavily matted section of uncombable hair" and (R1) was observed to be covered "from head to toe" with small lesions/sores from the recent scabies diagnosis. LPA was told during a phone call with the health care representative that (R1) had an odor during the visit on 6/5/24 and (R1) had expressed that she hadn't received a shower in weeks.

LPA interviewed (R1) on 6/27/24. (R1) stated she has refused a shower, now and then, when she was told she had to stand up for the shower; however, she has never refused a bed bath. (R1) stated to LPA that she is currently being given a shower, twice weekly, and she is asked to sign documentation she has either refused or accepted the shower. (R1) stated her sheets are currently being changed at the same time she receives a shower. LPA interviewed (3) staff who work with (R1). All staff stated that (R1) will refuse showers but will be offered one on the next shift (pm). Staff stated showers for (R1) are now being documented, due to resident often changing her mind. LPA reviewed documentation from 6/5/24 through 6/25/24. On 6/5/24 (no time of time noted), it is documented that (R1) told staff she did not want a shower but would take a bed bath, and one was given. (R1) received the next shower on 6/9/24, but refused to take a shower on 6/13/24 and 6/18/24, and a bed bath was not offered. The next shower is documented as being given on 6/19/24.

Based on information obtained, LPA finds the allegation 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: 06/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/27/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 06/27/2024 03:18 PM - It Cannot Be Edited

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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/27/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/11/2024
Section Cited
CCR
87464(d)

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87464 Basic Services (d) A facility need not accept a particular resident for care. However, if a facility chooses to accept a particular resident for care, the facility shall be responsible for meeting the resident's needs as identified in the pre-admission appraisal specified in Section 87457, Pre-admission Appraisal and providing the other basic services specified below, either directly or through outside resources. This requirement is not met as evidenced by.
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Licensee/Assistant Administrator agree to continue asking (R1) to sign documentation when a shower/bath is accepted/refused.

There is no additional action needed for this POC.
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Based on interviews conducted and documentation reviewed, the faciity did not ensure that (R1) received a shower/bath for multiple days, following the one given on 6/9/24, until the next one was given on 6/19/24, which posed a potential health and safety risk to residents in care.
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(R1) stated on 6/27/24, she is now receiving regular showers/bed baths.

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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: 06/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/27/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2