361800448-2-8-2023-18-AS-DMUN-CPSPJV-20230310102210

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361800448
Report Date: 02/08/2023
Date Signed: 02/08/2023 04:38:26 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/30/2020 and conducted by Evaluator Stephanie Torres

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200730145410

FACILITY NAME:	SUNRISE ASSISTED LIVING AT ALTA LOMA		FACILITY NUMBER:	361800448
ADMINISTRATOR:	CARL CARNEY		FACILITY TYPE:	740
ADDRESS:	9519 BASELINE RD		TELEPHONE:	(909) 941-3001
CITY:	RANCHO CUCAMONGA	STATE: CA	ZIP CODE:	91730
CAPACITY:	77	CENSUS: 56	DATE:	02/08/2023
		UNANNOUNCED	TIME BEGAN:	01:50 PM
MET WITH:	Jennifer Serrano Sanchez, Business Office Coordinator		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Facility staff are not allowing residents to participate in planned activities
Facility staff are isolating residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Stephanie Torres, conducted an unannounced visit to the facility to deliver the findings of the investigation into the above allegations. The LPA met with Jennifer Serrano Sanchez, Business Office Coordinator (BOC), and informed her of the purpose of her visit.

A report was received alleging the facility was not providing residents with activities on or around July 30, 2020. The LPA conducted staff and resident interviews; interviews reported the facility was providing one on one activities with residents, including taking residents for walks outdoors. In addition, a log of activities provided to residents in care was observed on file. Therefore, based on interviews and records, this allegation is deemed UNFOUNDED.

A report was received alleging the facility was isolating residents in their bedrooms due to current COVID-19 (C19) guidance. Staff and resident interviews revealed staff would redirect residents to their bedrooms when they were observed in common areas of the facility. Interviews reported staff did tell residents to stay in their

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 248-8031
LICENSING EVALUATOR NAME: Stephanie Torres	TELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023

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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Control Number 18-AS-20200730145410

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: SUNRISE ASSISTED LIVING AT ALTA LOMA	FACILITY NUMBER: 361800448
	VISIT DATE: 02/08/2023

NARRATIVE

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bedrooms, though there were no repercussions if residents did not comply. Further interviews revealed staff would routinely check on residents in their bedrooms during meal deliveries, activities, and routine status checks. In addition, a review of the Department's log of COVID-19 (C19) positive cases by facility, found there to be four (4) C19+ cases in July 2020. The Department's C19 guidance provided to facilities at the time was to take additional preventative measures, including serving all meals to all persons in their rooms, canceling group activities, and limiting visitors. Therefore, based on interviews and records review, this allegation is deemed UNFOUNDED.

A finding that the complaint is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

This report was reviewed with Serrano and a copy was provided.

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 248-8031
LICENSING EVALUATOR NAME: Stephanie Torres	TELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/30/2020 and conducted by Evaluator Stephanie Torres

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200730145410

FACILITY NAME:	SUNRISE ASSISTED LIVING AT ALTA LOMA		FACILITY NUMBER:	361800448
ADMINISTRATOR:	CARL CARNEY		FACILITY TYPE:	740
ADDRESS:	9519 BASELINE RD		TELEPHONE:	(909) 941-3001
CITY:	RANCHO CUCAMONGA	STATE: CA	ZIP CODE:	91730
CAPACITY:	77	CENSUS: 56	DATE:	02/08/2023
		UNANNOUNCED	TIME BEGAN:	01:50 PM
MET WITH:	Jennifer Serrano, Business Office Coordinator		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Facility staff did not assist resident with dressing needs
Resident did not have required linens on their bed
Facility staff did not safeguard resident's money
Resident has sustained multiple falls
Facility staff did not report falls to the resident's hospice care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Stephanie Torres, conducted an unannounced visit to the facility to deliver the findings of the investigation into the above allegations. The LPA met with Jennifer Serrano, Business Office Coordinator (BOC), and informed her of the purpose of her visit.

A report was received by the department reporting facility staff allegedly failed to assist Resident One (R1) with their dressing needs leading to R1 being found in only an adult diaper. One interview reported R1 was observed to be found in only an adult diaper, however, the circumstances of the incident were unknown. R1 was interviewed and denied the incident occurred. Therefore, due to insufficient information, this allegation is deemed UNSUBSTANTIATED at this time.

It was also reported facility staff allegedly failed to provide R1 with blankets/linens. Staff interviews revealed no knowledge of the alleged incident. R1 was interviewed and denied the allegation. Therefore, due to insufficient information, this allegation is deemed UNSUBSTANTIATED at this time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 248-8031
LICENSING EVALUATOR NAME: Stephanie Torres	TELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023

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

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 18-AS-20200730145410

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: SUNRISE ASSISTED LIVING AT ALTA LOMA	FACILITY NUMBER: 361800448
	VISIT DATE: 02/08/2023

NARRATIVE

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Another report was received alleging facility staff did not safeguard R1's money, when $50 was discovered to be missing on or around July 23, 2020. R1 was interviewed and reported the incident did take place, though no details were known as to how the money went missing. A file review was conducted, and no reports were found regarding the matter. One staff interview revealed an internal investigation was conducted regarding the matter; however, no further information was available. Therefore, due to insufficient information, this allegation is deemed UNSUBSTANTIATED at this time.

It was also reported R1 sustained multiple falls while in care at the facility. R1 was interviewed and reported they did sustain one fall while in care of the facility. The resident reported the one fall did not take place in July 2020. It was also reported the fall resulted in the resident sustaining a bruise. The resident's hospice agency was contacted and reported there was only one fall reported to have taken place on July 26, 2020. A record review was conducted; a Hospice Aide Communication Note, dated July 27, 2020, revealed R1 was observed to have discoloration on the right side of ribs, as well as the right and left side of arms. Therefore, due to insufficient information, this allegation is deemed UNSUBSTANTIATED at this time.

In addition, it was also reported facility staff allegedly did not report R1's falls to the resident's hospice care agency. R1 reported to have had only one fall while in care of the facility. R1's hospice agency reported being notified of only one fall for R1 on July 27, 2020. Staff interviews reported having no knowledge of any falls sustained by the resident. Two Resident/General Liability Incident Reports were obtained by the LPA; each documenting slips/falls sustained by the resident. The first report shows a slip/fall occurred on July 20, 2020; however, the report was not completed, leaving details of the incident unfinished. The second report shows a slip/fall occurred on July 26, 2020; according to the report R1 was found on the floor near restroom and the resident stated they lost their balance. Therefore, due to a lack of information, this allegation is deemed UNSUBSTANTIATED at this time.

A finding that the complaint is unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

This report was reviewed with BOC Serrano and a copy was provided.

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 248-8031
LICENSING EVALUATOR NAME: Stephanie Torres	TELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023

LIC9099 (FAS) - (06/04)

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