347004346-12-7-2023-59-AS-MSEY-CYEMBN-20231211082809

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347004346
Report Date: 12/07/2023
Date Signed: 12/07/2023 12:39:06 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
06/16/2023 and conducted by Evaluator Kevin Mknelly

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20230616114554

FACILITY NAME:	SUNRISE ASSISTED LIVING OF CARMICHAEL		FACILITY NUMBER:	347004346
ADMINISTRATOR:	TANIA LANGLAND		FACILITY TYPE:	740
ADDRESS:	5451 FAIR OAKS BLVD		TELEPHONE:	(916) 485-4500
CITY:	CARMICHAEL	STATE: CA	ZIP CODE:	95608
CAPACITY:	66	CENSUS: 51	DATE:	12/07/2023
		UNANNOUNCED	TIME BEGAN:	10:40 AM
MET WITH:	Barbara Barron		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Staff violated resident's personal rights.

INVESTIGATION FINDINGS:

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On 12/7/23, Licensing Program Analyst (LPA) Kevin Mknelly spoke with Barbara Barron, Senior Executive Director/ Interum Administrator, to deliver complaint findings for the above allegation.

LPA reviewed resident records, facility records and conducted interviews.
LPA finds that the allegations cited above are substantiated.

Staff violated resident's personal rights- Between R1’s admission on 11/30/22 and 3/7/23, R1 was regularly visited at the facility by a well known friend. On 3/8/23, an incident occurred at the facility where police responded to assess R1’s wellbeing. The Police determined that R1 was not being harmed by facility staff. R1’s Conservator requested, to the police officer, that the friend be escorted from the property. According to Sunrise Progress notes for R1, R1’s Conservator stated to the facility Executive Director (ED) that the Conservator would pursue a court order to limit the friend’s access to visit R1.
During this investigation, the licensee was unable to provide proof that the Conservator had a court order to limit individuals’ visitation to R1, nor was there a police issued restraining order.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin Mknelly	TELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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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
06/16/2023 and conducted by Evaluator Kevin Mknelly

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20230616114554

FACILITY NAME:	SUNRISE ASSISTED LIVING OF CARMICHAEL		FACILITY NUMBER:	347004346
ADMINISTRATOR:	TANIA LANGLAND		FACILITY TYPE:	740
ADDRESS:	5451 FAIR OAKS BLVD		TELEPHONE:	(916) 485-4500
CITY:	CARMICHAEL	STATE: CA	ZIP CODE:	95608
CAPACITY:	66	CENSUS: 51	DATE:	12/07/2023
		UNANNOUNCED	TIME BEGAN:	10:40 AM
MET WITH:	Barbara Barron		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Staff lack of care and supervison lead to resident hospitalization for illness and injury.

INVESTIGATION FINDINGS:

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On 12/7/23, Licensing Program Analyst (LPA) Kevin Mknelly conducted an unannounced complaint investigation visit to deliver the findings for the above allegations and met with Barbara Barron, acting Executive Director.

LPA conducted records review, interviews and attempted to get medical records.
LPA is unable to find and or meet the preponderance, per policy.

Staff lack of care and supervision lead to resident hospitalization for illness and injury- alleged R1 was admitted with to the hospital on 3/18/23 with diagnosis of UTI, severe dehydration, sepsis, broken finger and bruised foot.
Records found that on 3/1/23, R1 was in fair health and had a 6 pound weight gain from the prior measure.Records found that on 3/12/23 R1 sustained an unwitnessed "pinky injury". R1's Primary physician (PCP) was notified of the injury and care provided by facility nurse. PCP informed. On 3/15/23 R1's PCP acknowledged the message and the and there were no orders for emergency care. R1 had no

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin Mknelly	TELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023

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-20230616114554

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: 12/07/2023

NARRATIVE

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noted changes in function of increased pain. Constipation was noted noted in Progress notes on 3/15/23. Again, R1's activity, function and food intake were unchanged.
On 3/18/23, R1 was observed to be experiencing: lethargic, low food intake, weakness, finger injured swollen. The facility initiated medical evaluation. The facility staff were notified on 3/19/23 by the hospital, that R1's "kidneys do not look good." (R1 had a prior history of kidney disease.) On 3/25/23, progress notes noted a call from hospital that R1 was now experiencing dehydration. When R1 returned to the facility on 4/29/23, that R1's weight was then 142 lbs.
LPA made repeated attempts to obtain Hospital records. The hospital records were not released to this LPA. Therefore, conditions at hospital admission nor the course of R1's care while hospitalized could not be confirmed.
Care plan and care notes showed care provided as agreed to.

As a result of this investigation, LPA finds allegation to be (US)Unsubstantiated - A finding that the complaint 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 with administrator.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin Mknelly	TELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023

LIC9099 (FAS) - (06/04)

Page: 5 of 5

Control Number 59-AS-20230616114554

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: 12/07/2023

NARRATIVE

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However, the Sunrise Service Plan, provided to LPA, regarding R1 states (the friend) is not allowed on Sunrise property- call the sheriff and Conservator if (the friend) comes to Sunrise.
As R1’s Service Plan states such a visitation restriction and it was based on a direction from R1’s Conservator, who did not have legal ground to set such limitations, this allegation is substantiated.
R1 was allowed other visitors and progress notes did not note requests for the friend nor was there a change noted to R1’s overall emotional status as a result of the lack of (the friend) visitation.

As a result of this investigation, LPA finds allegation 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. The following deficiencies were cited on 9099-D, per Title 22 Regulations, Division 6. (A)This poses an immediate Health and Safety risk to clients/residents in care. (B) This poses a potential Health and Safety risk, or personal rights violation, to clients/residents in care.

Report reviewed with Barbara Barrob . Copy of this report and appeal rights provided.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin Mknelly	TELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 59-AS-20230616114554

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: 12/07/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 01/04/2024 Section Cited CCR 87468.1(a)(11)	1 2 3 4 5 6 7	Personal Rights of Residents in All Facilities (a) (11) To have their visitors, including ombudspersons and advocacy representatives, permitted to visit privately during reasonable hours and without prior notice, provided that the rights of other residents are not infringed upon.	1 2 3 4 5 6 7	Licensee will submit proof of training of all staff regarding the rights of resident visitation and the conditions under which visitation may be restricted by others. The training content and proof of training will be submitted to this LPA by the POC date of 1/4/24.
	8 9 10 11 12 13 14	This requirement was not met based on statements and records. This posed a potential risk to R1.	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: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin Mknelly	TELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 5