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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700705
Report Date: 07/11/2024
Date Signed: 07/11/2024 03:45:30 PM


Document Has Been Signed on 07/11/2024 03:45 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: 69DATE:
07/11/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Karen Padilla, Director of Nursing TIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived to conduct a case management inspection related to a recent incident report submitted for resident (R1), who is conserved. LPA met Karen Padilla, Director of Nursing (DON) and stated the reason for today's inspection.

LPA and DON discussed a recent incident where resident (R1), who resided in the Assisted Living portion of the community, was able to leave the facility unassisted, on 7/6/24, Saturday, around 1:30 pm. When (R1) was discovered missing, (4) staff members immediately went outside to look for him, and the Assistant Administrator was notified, who contacted the police, also at that time (1:45 pm). The police promptly informed the facility that they found (R1) four blocks away from the community, and resident was being taken to the hospital for an evaluation, in part due to the extreme outside temperatures that day. (R1) returned to the community with the Co-Administrator, from the hospital around 9:00 pm, and without having sustained any injuries. (R1's) care plan is being updated at this time and a new doctor is being sought for (R1), when an updated physician's report also be obtained.

LPA and DON reviewed (R1's) most recent physician's report which does not indicate a diagnosis of Dementia; however, notes that resident is not permitted to leave the facility unassisted. The report does not state that (R1) has any elopement tendencies, and this is not noted on the Pre-Appraisal Assessment either.
The Pre-Assessment states that resident can walk short distances; however, (R1) moved in using a wheelchair and continued to use it. DON stated that (R1) was able to leave the facility, on foot, which was not expected by staff, and staff are continually monitoring the front reception desk and lobby area. The incident report was submitted to the Department, on 7/10/24, along with a statement from the Assistant Administrator summarizing the information on the incident report.

There are no deficiencies issued on this report. The facility promptly followed their missing person protocol and moved (R1) to the Memory Care Unit.

LPA and DON discussed follow up training and discussions, including but not limited to: staff training with reception staff, review physician's reports and compose a list of which residents cannot leave unassisted, staff elopement training, install a door bell ring camera at the front door,review Regulation 87705. DON agrees to submit documentation of the above by 7/25/24. Exit interview. Copy of report provided.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 07/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/11/2024
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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