374603395-11-30-2020-08-AS-SJAB-BVUV48-20201130150555

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603395
Report Date: 10/30/2020
Date Signed: 11/30/2020 10:17:34 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/10/2019 and conducted by Evaluator Daniel Pena

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20190910121207

FACILITY NAME:	SUNRISE ASSISTED LIVING AT LA JOLLA		FACILITY NUMBER:	374603395
ADMINISTRATOR:	HOLLINGSWORTH, TRACI		FACILITY TYPE:	740
ADDRESS:	810 TURQUOISE ST		TELEPHONE:	(858) 488-4300
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92109
CAPACITY:	76	CENSUS: 46	DATE:	10/30/2020
		UNANNOUNCED	TIME BEGAN:	12:55 PM
MET WITH:	Traci Hollingsworth, Executive Director		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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-Resident's room is unkempt
-Staff failed to provide adequate hygiene care for resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Daniel Pena, conducted an announced complaint visit regarding the above-mentioned allegation. The virtual visit was conducted via FaceTime due to COVID-19. LPA met with Executive Director, Traci Hollingsworth. LPA identified himself and explained the purpose of the virtual visit.

It was alleged that Resident #1’s (R1, see List of Confidential Names) room is unkempt and that staff failed to provide adequate hygiene care for resident. The Department’s investigation consisted of LPA observations, record reviews and interviews with residents, staff and outside sources. LPA also toured the facility and visited R1 in their room.

Investigation revealed that R1 received bathing and dressing assistance by Care Managers. Based on staff interviews and facility documentation, staff check and change R1’s undergarments after meals, bedtime and throughout the night, as needed. Facility log records confirmed staff conduct resident room checks every two hours and change undergarments when needed. Interviews and records indicated that in addition to housekeeping staff's weekly cleaning of resident rooms, care managers also perform

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tony Girolami	TELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Daniel Pena	TELEPHONE: (619) 994-7269
LICENSING EVALUATOR SIGNATURE:	DATE: 11/30/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2020

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 08-AS-20190910121207

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: SUNRISE ASSISTED LIVING AT LA JOLLA	FACILITY NUMBER: 374603395
	VISIT DATE: 10/30/2020

NARRATIVE

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incidental housekeeping during their rounds, as needed. Resident and outside source interviews did not reveal any issues with housekeeping or grooming.

The Department has investigated the complaint that R1’s room is unkempt, and staff failed to provide adequate hygiene care. Photographic evidence depicted R1’s room in a disorganized state and R1’s person requiring hygiene care; at the time the photographs were taken. However, record reviews and interview with residents, staff and outside sources, did not yield sufficient evidence to conclude an ongoing failure by the facility to provide R1 or other residents with adequate hygiene and housekeeping services. Although, the allegations are valid, the preponderance of evidence standard has not been met to prove the violations occurred. Therefore, the allegations are determined Unsubstantiated.

An exit interview was conducted with Director Hollingsworth and a copy of this report, Appeal and Licensee Rights (LIC 9058 01/16) and Confidential Names (LIC 811) were provided via electronic mail. An electronic mail confirmation was requested to be sent by the Director upon receipt of the documents.

SUPERVISOR'S NAME: Tony Girolami	TELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Daniel Pena	TELEPHONE: (619) 994-7269
LICENSING EVALUATOR SIGNATURE:	DATE: 11/30/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2020

LIC9099 (FAS) - (06/04)

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