347004346-5-16-2024-59-AS-MSEY-D5PL3V-20240528082431

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347004346
Report Date: 05/16/2024
Date Signed: 05/16/2024 05:00:21 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
01/19/2024 and conducted by Evaluator Angela Hood

COMPLAINT CONTROL NUMBER: 59-AS-20240119121758

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: 45	DATE:	05/16/2024
		UNANNOUNCED	TIME BEGAN:	02:20 PM
MET WITH:	Abby Johnson, Terrace Club Coordinator		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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-Staff are not ensuring that resident's hygiene needs are being met while in care.
-Staff are not allowing resident to make and receive private phone calls while in care.
-Staff are not ensuring that resident is provided with a sufficient amount of food while in care.
-Staff did not ensure that resident's dental needs were met while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Angela Hood arrived at the care home unannounced today, 5/16/24, and met with the Terrace Club Coordinator, Abby Johnson, to deliver complaint investigation findings into the above stated allegations.

During the course of the investigation, LPA conducted interviews, made observations, and obtained documentation pertinent to the investigation. LPA visited resident (R1) on 1/18/24 and 2/27/24.

************************************************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: 05/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024

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-20240119121758

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: 05/16/2024

NARRATIVE

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Allegation: Staff are not ensuring that resident's hygiene needs are being met while in care.
Interviews with the Reminiscence Coordinator (RC), Terrace Club Coordinator (TCC), staff (S1), and R1’s responsible party indicated that R1 is scheduled for assistance with bathing one time per week. RC and TCC indicated that if R1 refuses showering then care staff will offer on another day or another caregiver with try to encourage bathing. S1 stated that care staff check with R1 daily to find out if R1 would like to take a shower. R1’s responsible party indicated that care staff will try different strategies to encourage R1 to take showers. Interview with R1 indicated that care staff will provide them assistance when needed. Interview with witness indicated that R1 appeared well groomed. LPA observed R1 on 1/18/24 and 2/27/24 and R1 appeared to be well groomed and wearing clean clothing. According to facility’s Documentation Survey Reports dated November 2023, December 2023, and January 2024 indicated that bathing has been provided to R1 by care staff every 2-3 days. The Documentation Survey Reports also indicated that R1 is receiving grooming and dressing assistance from care staff at least twice daily.

Allegation: Staff are not allowing resident to make and receive private phone calls while in care.
According to the Superior Court of Sacramento documentation dated 12/21/23, R1 is to receive and make all phone calls through a Grandpad provided by R1’s responsible party. Prior to R1 receiving the Grandpad in February 2024, RC and TCC indicated that, when incoming calls were received for R1, they would instruct callers to contact R1’s responsible party to screen calls, due to a restraining order that was granted for 5 years, dated 9/11/20, restricting all contact with R1’s family member. Interview with R1 indicated that they can receive and make phone calls. R1 indicated that they receive phone calls from family and friends. R1 stated that they don’t use the phone to call out unless it is something important.

Allegation: Staff are not ensuring that resident is provided with a sufficient amount of food while in care.
Interview with RC indicated that R1 mostly eats meals in the dining area. Interview with S1 indicated that R1 will order their food, eat it, forget they ate, and order more food. S1 stated that the facility keeps snacks on hand as well when residents want a snack. R1’s responsible party indicated that R1 is eating three meals per day. Interviews conducted with R1 indicated that the food is good and that they get enough to eat at the care home. LPA toured the kitchen area with the Dining Services Coordinator (DSC) and the facility has the required 2-day perishable and 7-day nonperishable food supply on hand. LPA was provided the food menus
**********************************************Continued on LIC9099-C************************************************

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 214-0485
LICENSING EVALUATOR NAME: Angela Hood	TELEPHONE: 650-676-0390
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024

LIC9099 (FAS) - (06/04)

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Control Number 59-AS-20240119121758

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: 05/16/2024

NARRATIVE

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for January-May 2024 indicating a variety of food options for the residents in care. The facility has a binder indicating any special diets in the care home. DSC indicated that they have food delivered to the care home twice per week.

Allegation: Staff did not ensure that resident's dental needs were met while in care.
Interview with RC and TCC indicated that the facility has a dental hygienist come to the facility frequently to provide services to the residents in care. RC and TCC indicated that R1’s responsible party was notified when the dental hygienist was in the facility. Interview with R1’s responsible party indicated that, the next time the dental hygienist is at the care home, they will have R1 seen for services. Email correspondence between the facility and R1’s responsible party indicated that R1’s responsible party would like to be contacted the next time the facility offers dental services. Interview with R1 indicated that they have gone to the dentist with their private caregiver since residing at the care home.

Based on interviews conducted, documentation obtained, and observations, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Therefore, the allegations are 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: 05/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024

LIC9099 (FAS) - (06/04)

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