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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700705
Report Date: 11/04/2022
Date Signed: 11/04/2022 01:08:32 PM


Document Has Been Signed on 11/04/2022 01:08 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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926



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: 41DATE:
11/04/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Kaye Key, Administrator TIME COMPLETED:
01:10 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a case management inspection to follow up on several incident reports (LIC624) received in October 2022. LPA met with Kaye Key, Administrator, who returned to the community around 11:50 am. Currently, there are (41) residents and (7) residents on hospice. Prior to initiating today's inspection, LPA completed required COVID-19 protocols and was screened per Covid-19 precautionary measures upon entering the facility. and was wearing a surgical mask.LPA and Administrator discussed (3) incident reports (LIC624), as follows:

Resident (R1) was sent to the Emergency Room on 10/25/22 due to the calluses draining on one foot and a skin tear on the other and for pain. R1 returned to the community in the evening and was prescribed antibiotics for 10 days. R1 is currently receiving treatment via home health, 2x/week and also is seen by a podiatrist every 2 months while at the community.

Resident (R2) was sent to the Emergency Room on 10/25/22 due to displaying weakness, eating less and vomiting and was admitted with a diagnosis of UTI. R2 received IV antibiotics at the hospital and was discharged the following morning with a prescription for oral antibiotics. Administrator indicated that the previous allegations that the facility was giving R2 more Seroquel than what was prescribed went unfounded. Administrator also stated that the ER nurse contacted the facility on 10/28/22 and told Administrator she would assist R2 in moving due to these same allegations that previously went unfounded. R2 will be moving out by 11/30/22. R2 is improving daily, eating and drinking well and back to her baseline.

Resident (R3) went to the ER on 10/10/22 after falling and received (4) staples in her head. R3 had the staples removed and has recovered, using her walker regularly. R3 fell when trying to open her door.

It appears the facility took appropriate action in sending residents out for further medical evaluation. There are no deficiencies cited in this report. Exit interview. Copy of report provided to Administrator.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 11/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/04/2022
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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