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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700705
Report Date: 03/30/2022
Date Signed: 03/30/2022 02:52:02 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/06/2022 and conducted by Evaluator Bethany Mirlohi
COMPLAINT CONTROL NUMBER: 25-AS-20220106142406
FACILITY NAME:SUN OAK ASSISTED LIVINGFACILITY NUMBER:
342700705
ADMINISTRATOR:KEY, KAYEFACILITY TYPE:
740
ADDRESS:7241 CANELO HILLS DRIVETELEPHONE:
(916) 722-2800
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:78CENSUS: 36DATE:
03/30/2022
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Kaye Key, AdministratorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Resident developed open sores while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to open allegations listed above. LPA met with Administrator Kaye Key during today's inspection outside of the facility. LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Masks.
LPA investigated allegation, “Resident developed open sores while in care”. LPA interviewed facility staff, reviewed facility documentation, and reviewed hospice documents. Interviews with facility staff indicate resident did develop a rash while in care but were not aware of any open sores on R1. LPA reviewed hospice documents which indicate in December 2021 R1 developed a rash however hospice documents did not show R1 had an open sore. Due to the information gathered LPA finds allegation to be UNFOUNDED.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany MirlohiTELEPHONE: (916) 591-1072
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022
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 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/06/2022 and conducted by Evaluator Bethany Mirlohi
COMPLAINT CONTROL NUMBER: 25-AS-20220106142406

FACILITY NAME:SUN OAK ASSISTED LIVINGFACILITY NUMBER:
342700705
ADMINISTRATOR:KEY, KAYEFACILITY TYPE:
740
ADDRESS:7241 CANELO HILLS DRIVETELEPHONE:
(916) 722-2800
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:78CENSUS: 36DATE:
03/30/2022
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Kaye Key, AdministratorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility does not have hot water
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to open allegations listed above. LPA met with Administrator Kaye Key during today's inspection outside of the facility. LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Masks.
LPA investigated allegation, “Facility does not have hot water”. LPA interviewed staff, administrator, and reviewed documentation. Documentation indicates the memory care unit in 1 hallway did not have hot water from 12/18/21 to 1/3/22. The water heater went out in the B hallway, and maintenance director worked on having several companies come out to the facility to fix the issue.
Continuation on 9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany MirlohiTELEPHONE: (916) 591-1072
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 25-AS-20220106142406
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: SUN OAK ASSISTED LIVING
FACILITY NUMBER: 342700705
VISIT DATE: 03/30/2022
NARRATIVE
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Receipts indicate hot water heater was replaced on 1/3/22 and it fixed the issue. LPA interviewed caregivers in which they stated while the hot water was out in B hallway, they would take residents to an empty room where there was hot water and give showers. Caregivers indicated they never gave any of the residents a shower with the cold water. Due to the information gathered LPA finds that facility did not have hot water in part of the memory care however facility diligently worked on fixing the issue and had hot water available in other parts of the facility. LPA finds allegation to be UNSUBSTANTIATED.

Exit interview conducted.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany MirlohiTELEPHONE: (916) 591-1072
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/06/2022 and conducted by Evaluator Bethany Mirlohi
COMPLAINT CONTROL NUMBER: 25-AS-20220106142406

FACILITY NAME:SUN OAK ASSISTED LIVINGFACILITY NUMBER:
342700705
ADMINISTRATOR:KEY, KAYEFACILITY TYPE:
740
ADDRESS:7241 CANELO HILLS DRIVETELEPHONE:
(916) 722-2800
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:78CENSUS: 36DATE:
03/30/2022
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Kaye Key, AdministratorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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9
Resident developed a rash while in care
Staff left resident in soiled diapers for an extended period of time
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to open allegations listed above. LPA met with Administrator Kaye Key during today's inspection outside of the facility. LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Masks.
LPA investigated allegation, “Resident developed a rash while in care”. LPA interviewed relevant parties, care staff, and reviewed hospice and facility documents. R1 was receiving hospice services, and according to R1’s LIC602 resident required help from caregivers with continence care and medications. LPA interviewed 8 facility staff, and caregivers stated R1 needed assistance with continence care, bathing, medications, and reminders for meals and activities.
Continuation on 9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany MirlohiTELEPHONE: (916) 591-1072
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 25-AS-20220106142406
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: SUN OAK ASSISTED LIVING
FACILITY NUMBER: 342700705
VISIT DATE: 03/30/2022
NARRATIVE
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Interviews with care staff indicate R1 had behaviors of refusing continence care and bathing. LPA reviewed hospice documentation in which it states on December 14th hospice indicated there were no skin issues for R1. Hospice documents indicate on December 16, 2021 R1’s family found resident in a soiled depend and a skin rash was observed. Hospice documents show R1 had a “Newly excoriated area” that was pink in color. R1 was prescribed clotrimazole cream and anti-fungal powder and cream for the rash. Interviews with care staff indicate R1 did develop a rash while in care and R1’s family was the one to notify staff of the rash. In addition, LPA interviewed administrator in which she stated the rash looked like a “urine burn” and training was provided to staff. LPA interviewed relevant party in which they state R1 developed a rash, and was found to be in a soiled depend. Due to the information gathered LPA finds allegations to be SUBSTANTIATED.

LPA investigated the allegation, “Staff left resident in soiled diapers for an extended period of time”. LPA interviewed 8 facility staff, relevant party, and reviewed hospice and facility documents. LPA interviewed care staff in which they stated R1 needed assistance with continence care, bathing, medications, and reminders for meals and activities. Interviews with care staff indicate R1 had behaviors of refusing continence care and bathing. Interviews with care staff indicate resident was found by family to be in soiled diaper and a rash developed. Care staff did not know how long R1 was left in a soiled diaper. 1 caregiver indicated there was communication breakdowns between each shift and oncoming shifts were not made aware when R1 refused care. Care staff indicated once the rash was discovered facility staff worked on different care tactics when R1 refused care and R1’s rash began to heal. LPA reviewed hospice documentation in which it states on December 14th hospice indicated there were no skin issues for R1. Hospice documents indicate on December 16, 2021 R1’s family found resident in a soiled depend and a skin rash was observed. Hospice documents show R1 had a “Newly excoriated area” that was pink in color. Hospice documents show training was provided to facility staff. LPA interviewed relevant party in which they indicated R1 was found to be in a soiled depend and it appeared R1 had not been changed for an extended amount of time. Relevant party stated R1’s private area was “raw” and a rash developed.
Continuation on 9099-C.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany MirlohiTELEPHONE: (916) 591-1072
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 25-AS-20220106142406
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: SUN OAK ASSISTED LIVING
FACILITY NUMBER: 342700705
VISIT DATE: 03/30/2022
NARRATIVE
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LPA interviewed administrator in which she stated she observed the depend to be full and dirty and resident developed a “urine burn”. Administrator stated training was provided to staff. Due to the information gathered, LPA finds the allegation to be SUBSTANTIATED.

As a result of this investigation, LPA finds allegations to be (S) Substantiated - A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

Deficiencies cited on 9099-D.

Exit interview conducted and appeal rights provided.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany MirlohiTELEPHONE: (916) 591-1072
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 25-AS-20220106142406
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: SUN OAK ASSISTED LIVING
FACILITY NUMBER: 342700705
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/30/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/01/2022
Section Cited
CCR
87625(b)(7)
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87625 Managed Incontinence. (b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (7) Ensuring that the condition of the skin exposed to urine and stool is evaluated regularly to ensure that skin breakdown is not occurring.
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Administrator agrees to conduct a training with all care staff on incontinence care and refusals of care. Training subjects to be sent into CCL on 4/01/22.
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This requirement is not met as evidenced by: Based on interviews and record review R1 developed a rash which poses an immediate health and safety risk to residents in care.
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Type B
04/08/2022
Section Cited
CCR
87625(b)(3)
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87625 Managed Incontinence. (b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence.
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Administrator agrees to conduct a training with all care staff on incontinence care and refusals of care. Training subjects and staff sign in sheet to be sent into CCL on 4/08/22.
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This requirement is not met as evidenced by: Based on interviews and record review R1 was left in a soiled depend for an extended amount of time which poses a potential risk to residents in care.
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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: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany MirlohiTELEPHONE: (916) 591-1072
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022
LIC9099 (FAS) - (06/04)
Page: 7 of 7