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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347001957
Report Date: 10/16/2024
Date Signed: 10/16/2024 11:43:44 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/03/2024 and conducted by Evaluator Michael Hood
COMPLAINT CONTROL NUMBER: 59-AS-20241003174020
FACILITY NAME:SUNRISE ASSISTED LIVING OF FAIR OAKSFACILITY NUMBER:
347001957
ADMINISTRATOR:MOORE, JONATHONFACILITY TYPE:
740
ADDRESS:4820 HAZEL AVETELEPHONE:
(916) 863-1499
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY:74CENSUS: 55DATE:
10/16/2024
UNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Cortez Jordan, Senior Executive DirectorTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Staff does not respond to resident's call for assistance in a timely manner
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Michael Hood and Cassie Mikkelson arrived at the facility and met with Senior Executive Director (SED), Cortez Jordan, to deliver findings regarding the complaint allegation listed above.

During the investigation, LPAs conducted interviews and reviewed documentation pertinent to the investigation. The results of the investigation are as follows:

Allegation: Staff does not respond to resident's call for assistance in a timely manner

** Report continued on 9099-C **
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Michael Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2024
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
Control Number 59-AS-20241003174020
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: SUNRISE ASSISTED LIVING OF FAIR OAKS
FACILITY NUMBER: 347001957
VISIT DATE: 10/16/2024
NARRATIVE
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Interviews with residents R1, R2, R3, R4, and relevant party indicated that the facility does not have sufficient staff to meet the residents' care needs. R1 stated that they've had to wait about an hour for a response from care staff with their call button. R1 stated that there are too many residents in need for staff to care for and they don't get enough time to care for the residents. R2 stated that there are a lot of residents in need of assistance and some caregivers are pulling two wheelchairs at the same time. R2 stated that caregivers cannot spend enough time with residents because there are too many residents in need of assistance for the amount of caregivers on shift. R3 stated response times to call buttons are never ten (10) minutes and they've had to wait an hour for assistance after sustaining a fall. R4 stated that management reduced the amount of staff on duty at any given time and has had to wait an hour for a response to their call button. Interview with relevant party indicated that caregivers don't even have enough time to talk with residents and are stretched thin. Relevant party stated that staff want to provide care to residents, but just can't due to there not being enough staff on duty.

Interviews with staff members S1, S3, and S4 indicated that standard response times to resident call buttons should be within ten (10) minutes. Interview with S1 indicated that R1 has had to wait forty-five (45) minutes to receive assistance to the dining room due to S1 needing to provide care to other residents. Interview with staff member (S2) indicated that they can take fifteen (15) to twenty-five (25) minutes to respond to a call button. S2 stated that there are a lot of residents who need assistance from staff and they can't "do everything at once." S2 stated that they may not have time to respond to a call button due to providing care to someone else. S2 stated that they feel staffing is "terrible" at the facility. Interview with S3 indicated that staff get busy and can't assist residents timely. S3 stated that they feel the facility is short on staffing. Interview with S4 indicated that "everything" is not being responded to timely and they "definitely" feel there should be more staff on duty.

** Report continued on 9099-C **
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Michael Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 59-AS-20241003174020
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: SUNRISE ASSISTED LIVING OF FAIR OAKS
FACILITY NUMBER: 347001957
VISIT DATE: 10/16/2024
NARRATIVE
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LPAs obtained and observed facility's Emergency Needs Response, which states "response call logs are reviewed at community morning meetings and monthly Quality Assurance meetings. All calls exceeding a 10 minute time response will be reviewed further." LPAs observed call button logs for resident R1, R2, R3, R4, R5, R6, R7, R8, and R9 for the month of September 2024. LPA observed multiple call button response times exceeding 10 minutes and reaching as long as 419 minutes. LPAs toured the facility and observed that it took 12 minutes to walk the interior and exterior parameter of the care home.

Based on interviews conducted and records reviewed, 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, deficiencies are being cited on the attached 9099-D page.

Exit interview was conducted with ED. A copy of this report and appeal rights were provided. ED's signature on these forms acknowledges receipt of these documents.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Michael Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 59-AS-20241003174020
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SUNRISE ASSISTED LIVING OF FAIR OAKS
FACILITY NUMBER: 347001957
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/31/2024
Section Cited
CCR
87411(a)
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87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement is not met as evidenced by:
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Facility will develop a plan to address staffing and submit plan to LPA by POC due date.
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Based interviews conducted and records reviewed, the facility did not ensure call buttons for residents were responded to in a timely manner, resulting in response times reaching as long as 419 minutes, which poses a potential health, safety, and personal rights 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.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Michael Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2024
LIC9099 (FAS) - (06/04)
Page: 4 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, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/03/2024 and conducted by Evaluator Michael Hood
COMPLAINT CONTROL NUMBER: 59-AS-20241003174020

FACILITY NAME:SUNRISE ASSISTED LIVING OF FAIR OAKSFACILITY NUMBER:
347001957
ADMINISTRATOR:MOORE, JONATHONFACILITY TYPE:
740
ADDRESS:4820 HAZEL AVETELEPHONE:
(916) 863-1499
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY:74CENSUS: 55DATE:
10/16/2024
UNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Cortez Jordan, Senior Executive DirectorTIME COMPLETED:
11:00 AM
ALLEGATION(S):
1
2
3
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Staff are not following resident's needs and services plan
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Michael Hood and Cassie Mikkelson arrived at the facility and met with Senior Executive Director (SED), Cortez Jordan, to deliver findings regarding the complaint allegation listed above. During the investigation, the Department conducted interviews and reviewed documentation pertinent to the investigation. Interviews conducted with residents R1, R2, R3, R4, relevant party, and staff members S1, S2, S3, and S4 indicated that they have never observed residents not receiving care as needed and caregivers at the facility are good with providing care.

Based on interviews conducted and records reviewed, 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 SED. A copy of this report was provided. Signature on these forms acknowledges receipt of these documents.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Michael Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 5