345002867-5-23-2023-59-AS-KHOS-CSCNXS-20230531105136

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 345002867
Report Date: 05/23/2023
Date Signed: 05/23/2023 04:41:22 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/18/2023 and conducted by Evaluator Michael Hood

COMPLAINT CONTROL NUMBER: 59-AS-20230518153648

FACILITY NAME:	SUNSHINE CARE HOME		FACILITY NUMBER:	345002867
ADMINISTRATOR:	CRISAN, ADELA		FACILITY TYPE:	740
ADDRESS:	5010 OLEAN STREET		TELEPHONE:	(916) 966-6042
CITY:	FAIR OAKS	STATE: CA	ZIP CODE:	95628
CAPACITY:	6	CENSUS: 4	DATE:	05/23/2023
		UNANNOUNCED	TIME BEGAN:	01:50 PM
MET WITH:	Adela Crisan, Administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Facility does not have hot water for resident in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Administrator, Adela Crisan, to open a complaint investigation into the allegation listed above.

During today's visit, LPA conducted interviews, observed the facility, and took the temperature of the tap water.

The results of the investigation are as follows:

Allegation: Facility does not have hot water for resident in care

** Report continued on 9099-C **

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Michael Hood	TELEPHONE: (916) 531-7341
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2023

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 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/18/2023 and conducted by Evaluator Michael Hood

COMPLAINT CONTROL NUMBER: 59-AS-20230518153648

FACILITY NAME:	SUNSHINE CARE HOME		FACILITY NUMBER:	345002867
ADMINISTRATOR:	CRISAN, ADELA		FACILITY TYPE:	740
ADDRESS:	5010 OLEAN STREET		TELEPHONE:	(916) 966-6042
CITY:	FAIR OAKS	STATE: CA	ZIP CODE:	95628
CAPACITY:	6	CENSUS: 4	DATE:	05/23/2023
		UNANNOUNCED	TIME BEGAN:	01:50 PM
MET WITH:	Adela Crisan, Administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff strap resident down and prevent resident from leaving bed

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Administrator, Adela Crisan, to open a complaint investigation into the allegation listed above.

During today's visit, LPA conducted interviews and toured the facility.

The results of the investigation are as follows:

Allegation: Staff strap resident down and prevent resident from leaving bed

** Report continued on 9099-C **

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Michael Hood	TELEPHONE: (916) 531-7341
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2023

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 5

Control Number 59-AS-20230518153648

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

FACILITY NAME: SUNSHINE CARE HOME	FACILITY NUMBER: 345002867
	VISIT DATE: 05/23/2023

NARRATIVE

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During today's visit, LPA conducted interviews with residents R1, R2, and R3, relevant party, and Administrators Adela and Denisa Crisan. All interviews with the individuals listed above indicated that they have never witnessed any residents being restrained at the facility. All resident interviews indicated that they never experienced staff physically restrain them. Interviews with staff indicated that they have never physically restrained a resident in care.

Interviews with R2, R3, and Administrators indicated that residents are able to wake up and go to sleep when they want to. All interviews listed above indicated that the facility has on-call staff at night that is available and has provided assistance at night when needed. LPA observed call horns for residents to alert on-call staff to be audible from throughout the facility to the on-call staff member's bedroom.

During today's visit, LPA observed residents ambulating throughout the facility. LPA observed no residents being physically restrained.

Based on interviews conducted and observations, the preponderance of evidence standards have not been met. Therefore, the above allegation is found to be UNSUBSTANTIATED. A finding that a complaint allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview was conducted with Administrator and a copy of this report was provided to the facility. The signature of the Administrator on these forms acknowledges receipt of these documents.

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Michael Hood	TELEPHONE: (916) 531-7341
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2023

LIC9099 (FAS) - (06/04)

Page: 5 of 5

Control Number 59-AS-20230518153648

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

FACILITY NAME: SUNSHINE CARE HOME	FACILITY NUMBER: 345002867
	VISIT DATE: 05/23/2023

NARRATIVE

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Interview with resident (R1) indicated that they have struggled getting hot water in their bathroom sink. Interview with resident (R3) indicated that they were unable to get hot water while taking a shower when they first moved to the facility, but facility increased hot water when brought to their attention and R3 no longer had issues with hot water.

During today's visit, LPA took the temperature of the tap water from three faucets. Faucet in one shared bathroom took ten minutes to get to 97 degrees F before dropping in temperature. Faucet in kitchen got to 102 degrees F before dropping in temperature. Faucet in resident (R2's) personal bathroom got up to 106 degrees F.

Based on interviews conducted and observation, the preponderance of evidence standards have been met. Therefore, the above allegation is found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency are being cited on the attached 9099-D page.

Exit interview was conducted with Administrator. A copy of this report and appeal rights were provided. Administrator's signature on these forms acknowledges receipt of these documents.

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Michael Hood	TELEPHONE: (916) 531-7341
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 59-AS-20230518153648

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

FACILITY NAME: SUNSHINE CARE HOME	FACILITY NUMBER: 345002867
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/23/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/16/2023 Section Cited CCR 87303(e)(2)	1 2 3 4 5 6 7	87303 Maintenance and Operation (e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care (...) shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Facility will work on regulating water temperature throughout the house so that water tap at the facility will have a temperature between 105 degrees F and 120 degrees F. LPA will return to the facility at a later time to take the temperatures of the water tap.
	8 9 10 11 12 13 14	Based on interviews conducted and observation, LPA observed 2 faucets at the facility run water under 105 degrees F before dropping in temperature, which poses an potential health, safety, and personal rights risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Michael Hood	TELEPHONE: (916) 531-7341
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 5