347004346-1-24-2024-59-AS-MSEY-CZUW45-20240126155659

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347004346
Report Date: 01/24/2024
Date Signed: 01/24/2024 03:38:41 PM

Unsubstantiated

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
12/04/2023 and conducted by Evaluator Angela Hood

COMPLAINT CONTROL NUMBER: 59-AS-20231204110215

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: 47	DATE:	01/24/2024
		UNANNOUNCED	TIME BEGAN:	11:20 AM
MET WITH:	Andy Pardede, Resident Care Director		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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-Staff are emotionally abusing resident in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Angela Hood arrived unannounced at the care home today, 1/24/24, and met with the Resident Care Director, Andy Pardede, to deliver complaint investigation findings into the above stated allegation.

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

*********************************************Continued on LIC9099-C***************************************************

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 214-0485
LICENSING EVALUATOR NAME: Angela Hood	TELEPHONE: 650-676-0390
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024

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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Control Number 59-AS-20231204110215

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: 01/24/2024

NARRATIVE

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Interviews conducted with residents (R1, R2, & R3) indicated that care staff treat them well. R1, R2, and R3 stated that they have never witnessed staff mistreating residents in care. R2 indicated that they have never witnessed staff emotionally abusing any residents and that they would say something if they saw something. R3 stated that they have never witnessed any type of abuse from staff towards residents in the care home.

Interviews with staff (S1 & S2) indicated that they have never witnessed staff emotionally abusing residents in care. Interview with staff (S3) indicated that they have never witnessed any type of abuse from staff towards residents in care. S3 indicated that they have never witnessed staff mistreating residents. S2 indicated that residents are treated respectfully and with dignity.

Based on interviews conducted, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is UNSUBSTANTIATED. No deficiencies are being cited during this visit.

Exit interview conducted. A copy of this report provided. Signature on these forms acknowledges receipt of these documents.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 214-0485
LICENSING EVALUATOR NAME: Angela Hood	TELEPHONE: 650-676-0390
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024

LIC9099 (FAS) - (06/04)

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