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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347005180
Report Date: 12/29/2021
Date Signed: 12/29/2021 09:41:05 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/16/2021 and conducted by Evaluator Anthony Tuck
COMPLAINT CONTROL NUMBER: 27-AS-20211116135524
FACILITY NAME:SUNRISE ASSISTED LIVING OF SACRAMENTOFACILITY NUMBER:
347005180
ADMINISTRATOR:SARA WEININGERFACILITY TYPE:
740
ADDRESS:345 MUNROE STTELEPHONE:
(916) 486-0200
CITY:SACRAMENTOSTATE: CAZIP CODE:
95825
CAPACITY:70CENSUS: 53DATE:
12/29/2021
UNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Administrator Sara WeiningerTIME COMPLETED:
09:45 AM
ALLEGATION(S):
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Facility is not providing copies of resident's records
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Anthony Tuck arrived at the facility unannounced and was met by Administrator Sara Weininger on 12/29/2021. LPA explained the purpose of today's visit to conclude the complaint investigation and review findings for the allegation listed above.
LPA conducted a phone interview with RP on 11/17/2021 and on 11/23/2021, LPA conducted an interview with ED on 11/18/2021 and a phone interview on 12/07/2021. LPA conducted a phone interview with W1 on 11/23/2021. LPA received and reviewed copies of documentation for request of records and delivery confirmation of records. Based on interviews conducted and review of supporting documentation, LPA discovered that although copies of requested records were provided to R1’s responsible party, LPA learned that resident records were not provided promptly.
The preponderance of evidence standard has been met, therefore the above allegation is found to be
substantiated. The following deficiency was observed (see LIC 9099-D) and cited from the California Health and Safety Code. Failure to correct the deficiency may result in civil penalties. Appeal rights were provided. Exit interview was conducted with Administrator. LPA generated the report for the administrator to sign. A copy of the report LIC 9099, LIC 9099-D, and appeal rights were provided to the Administrator.
Substantiated
Estimated Days of Completion: 90
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Anthony TuckTELEPHONE: (916) 708-6203
LICENSING EVALUATOR SIGNATURE:

DATE: 12/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2021
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 2
Control Number 27-AS-20211116135524
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: SUNRISE ASSISTED LIVING OF SACRAMENTO
FACILITY NUMBER: 347005180
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/29/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/07/2022
Section Cited
HSC
1569.269(a)(21)
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1569.269 Enumerated rights; severability
(a) Residents of residential care facilities for the elderly shall have…(21) To have prompt access to…records... Photocopied records shall be promptly provided, not to exceed two business days… This requirement was not met as evidenced by:
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Administrator will conduct in-service training on procedures to staff regarding resident records requests from residents responsible parties or designated representatives. Administrator will ensure that effective communication is practiced with staff and respective parties requests.
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Based upon interviews, telephone calls and documents obtained. The Licensee failed to ensure that prompt access of resident records were made available upon residents designated representative request. This poses a potential risk to persons in care.
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Administrator will submit proof of in-service training conducted to CCLD by POC due date.
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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.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Anthony TuckTELEPHONE: (916) 708-6203
LICENSING EVALUATOR SIGNATURE:

DATE: 12/29/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2021
LIC9099 (FAS) - (06/04)
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