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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347004346
Report Date: 09/24/2025
Date Signed: 09/24/2025 03:01:24 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, 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
07/23/2025 and conducted by Evaluator Angela Hood
COMPLAINT CONTROL NUMBER: 59-AS-20250723110818
FACILITY NAME:SUNRISE ASSISTED LIVING OF CARMICHAELFACILITY NUMBER:
347004346
ADMINISTRATOR:TANIA LANGLANDFACILITY TYPE:
740
ADDRESS:5451 FAIR OAKS BLVDTELEPHONE:
(916) 485-4500
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:66CENSUS: 39DATE:
09/24/2025
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Hazel Gober, Business Office CoordinatorTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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-Staff administered medication to resident in care without obtaining a physician's prescription order
-Staff did not complete required training
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angela Hood arrived at the care home today and met with the Business Office Coordinator, Hazel Gober, to deliver complaint investigation findings regarding the above stated allegations.

During the course of the investigation, LPA conducted interviews and obtained documentation pertinent to the investigation.

According to the facility’s Resident Handbill, resident (R1) moved into the care home on May 31, 2025. After Visit Summary and Physician Progress Notes, dated May 25, 2025, indicated that R1 was to begin taking Cefadroxil 500mg capsules for 7 days due to urinary tract infection (UTI). Interview with Executive Director (ED) Jessica Sanders, staff (S1), and witness indicated that R1 had 2 more days of medication to take upon
***********************************************Continued on LIC9099-C**************************************************
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Angela Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2025
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 4
Control Number 59-AS-20250723110818
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 CARMICHAEL
FACILITY NUMBER: 347004346
VISIT DATE: 09/24/2025
NARRATIVE
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move in. LPA reviewed R1’s Centrally Stored Medication and Destruction Records, Medication Order Summary Report, and the Medication Administration Record (MAR) which did not indicate the facility had a medication order for Cefadroxil 500mg capsules and there was no entry for the medication. Interview with ED indicated that they do not typically pass medications, however, they did one time when R1 moved into the care home. Interviews with S1, staff (S3), and witness indicated that ED provided R1 with their Cefadroxil 500mg capsules. Interviews with S1, S3, and staff (S4) indicated that typically the nurses and med techs pass medications. Interviews with S1, S2, and witness indicated that there were no medication orders for R1’s Cefadroxil 500mg capsules. According to facility’s Plan of Operation, “a resident may self-administer his or her own medications only when there is proper documentation from the physician”. The Plan of Operation also indicated that the facility is to “maintain a current residents with self-medication orders form in the Wellness Center”. To date, the facility was unable to provide LPA with a medication order for R1’s Cefadroxil 500mg capsules.

Interview with ED indicated that they have taken medication training as they are the ED of the care home. Interviews with S2, S4, and witness indicated that the facility has a policy to complete medication training if staff are going to be passing medications to residents in care. Interviews with S4, witness, and Business Office Coordinator indicated that the facility has required Medication Management training that staff are to complete if they will be passing medications. Upon review of ED’s training documentation that was provided, the ED does not have current medication management training. According to the facility’s Plan of Operation, “team members administering medications must fall under one (1) of the following areas: A licensed health care professional, has successfully completed a state approved medication training course, has completed a Sunrise medication training program, if a state approved medication training course is not required”. To date, the facility was unable to provide LPA with the ED’s current medication training documentation.

Based on interviews conducted and records reviewed, the preponderance of evidence standards have been met. Therefore, the above allegations are 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 conducted. A copy of this report and appeal rights were provided.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Angela Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 59-AS-20250723110818
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 CARMICHAEL
FACILITY NUMBER: 347004346
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/24/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/25/2025
Section Cited
CCR
87465(a)(4)
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87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility (...) by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by:
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Facility will conduct an in-service with staff regarding medication documentation. Facility will submit to LPA information regarding in-service training by POC due date of 9/25/25.
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Based on interviews and records reviewed, the facility assisted resident (R1) with a self-administered medication without a physician’s order, which poses an immediate health, safety, and personal rights risk to residents in care.
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Type B
10/08/2025
Section Cited
CCR
87208(a)
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87208 Plan of Operation (a) The licensee shall have and maintain a current, written definitive plan of operation for the facility. The licensee shall operate the facility in accordance with the terms specified in the plan of operation and may be cited for not doing so pursuant to Health and Safety Code section 1569.49. (…) This requirement is not met as evidenced by:
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Facility will provide LPA with a statement of understanding and submit by the POC due date of 10/8/25.
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Based on records reviewed, the facility did not ensure that a staff administering medications received training in accordance with the facility's Plan of Operation, 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: Maribeth Senty
LICENSING EVALUATOR NAME: Angela Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 59-AS-20250723110818
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 CARMICHAEL
FACILITY NUMBER: 347004346
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/24/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/08/2025
Section Cited
HSC
1569.69(a)(1)
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§1569.69 Employees assisting residents with self-administration of medication; training requirements (a) Each residential care facility for the elderly licensed under this chapter shall ensure that each employee of the facility who assists residents with the self-administration of medications meets all of the following training requirements: (1) In facilities licensed to provide care for 16 or more persons, the employee shall complete 24 hours of initial training. This training shall consist of 16 hours of hands-on shadowing training, which shall be completed prior to assisting with the self-administration of medications, and 8 hours of other training or instruction, as described in subdivision (f), which shall be completed within the first four weeks of employment. This requirement is not met as evidenced by:
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Facility will ensure that all staff administering medications receive training in accordance with the regulations. Facility will create a plan on how to ensure staff are meeting training requirements and submit plan to LPA by POC due date of 10/8/25. Facility plans on conducting a medication management training on 9/30/25 and will submit proof of training as well.
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Based on records reviewed and interviews conducted, the facility did not ensure a staff who administered a medication received the required training, 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: Maribeth Senty
LICENSING EVALUATOR NAME: Angela Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4