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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347004346
Report Date: 10/18/2022
Date Signed: 10/18/2022 01:19:35 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/01/2022 and conducted by Evaluator Cassie Yang
PUBLIC
COMPLAINT CONTROL NUMBER: 25-AS-20220801132459
FACILITY NAME:SUNRISE ASSISTED LIVING OF CARMICHAELFACILITY NUMBER:
347004346
ADMINISTRATOR:DAVINA BARKERFACILITY TYPE:
740
ADDRESS:5451 FAIR OAKS BLVDTELEPHONE:
(916) 485-4500
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:66CENSUS: 48DATE:
10/18/2022
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Christina BondTIME COMPLETED:
01:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff hit resident while in care.
Staff is handling resident in a rough manner.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 10/18/2022, Licensing Program Analyst (LPA) Cassie Yang arrived at the facility unannounced and met with Health Care Director, Christina Bond and explained the purpose of the visit was to deliver findings for the allegations cited above. LPA wore a surgical mask and was screened by facility upon entry.

Regarding staff hitting resident while in care and staff is handling resident in a rough manner, LPAs interviewed staff and all staff denied hitting and/or handling resident in a rough manner. LPA interviewed R1 who denied staff giving her bruises, hitting and/or handling R1 in a rough manner.

During the investigation, LPAs conducted interview with (1) reporting party, (11) staff, (1) resident, and (2) family members. LPA also reviewed R1’s resident records and home health reports. Based on interviews and record reviews, LPA finds allegation to be (U) UNFOUNDED - An unfounded allegation means that the allegation was false, could not have happened and/or is without a reasonable basis.
Exit interview with Health Care Director and a copy of the report and appeal rights was provided.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Cassie YangTELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2022
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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