374603395-6-16-2022-08-AS-DPOL-CFVPML-20220630112630

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603395
Report Date: 06/16/2022
Date Signed: 06/16/2022 09:44:53 AM

Unsubstantiated

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
03/25/2020 and conducted by Evaluator Elizabeth Hamilton

COMPLAINT CONTROL NUMBER: 08-AS-20200325163401

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: 52	DATE:	06/16/2022
		UNANNOUNCED	TIME BEGAN:	09:24 AM
MET WITH:	Executive Director, Paul Richardson		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Facility staff did not ensure that resident consumed adequate amount of fluids
Facility staff did not seek medical attention in a timely manner

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elizabeth Hamilton conducted an unannounced complaint investigation visit at the facility. LPA was greeted at the front entrance by Paul Richardson and granted entry after identifying herself. LPA Hamilton explained the purpose of the visit was to deliver findings for the above allegations.

The Department’s investigation consisted of record reviews, interviews with staff and outside sources.

On March 25, 2020, it was alleged that on or around March 24, 2020, facility staff did not ensure that Resident 1 (R1 – See LIC 811 Confidential Names List) consumed adequate amount of fluids. Records reviewed revealed R1 was at risk for dehydration. According to the agreed upon needs and services plan, they needed to be offered and encouraged to take fluids with activities and medications daily.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Elizabeth Hamilton	TELEPHONE: (619) 929-7590
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022

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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Control Number 08-AS-20200325163401

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: 06/16/2022

NARRATIVE

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The plan indicated R1 should be offered eight, eight-ounce glasses of water per day and offered shakes three times a day in between meals. Additional records reviewed confirmed R1 was admitted to the hospital on March 24, 2020 for a chronic health condition, urinary tract infection (UTI) and dehydration. Interviews with outside sources revealed R1 had a history of not liking to drink fluids. R1 had a refrigerator in their private room that contained water, Gatorade and juices, however, needed assistance accessing the items. R1 had a private caregiver with them for four hours daily including lunch service and had home health services two times a week. Although R1 needed to be encouraged to consume fluids, there were no concerns by outside agencies involved in R1’s care. There was insufficient evidence to support the allegation facility staff did not ensure that resident consumed adequate amounts of fluids.

On March 25, 2020, it was also alleged that on or around March 24, 2020, facility staff did not seek medical attention for R1 in a timely manner. Records reviewed revealed on March 23, 2020, the facility called the paramedics to send R1 to the hospital for a distended abdomen and complaints of pain. However, R1 refused the ambulance service, despite paramedic’s recommendation that they go to the hospital for further evaluation. The next day, on March 24, 2020, R1 was transported to the hospital via ambulance for distended and tender abdomen and complaints of left leg pain. R1 was admitted with an obstructed catheter, UTI, dehydration and a contusion to the left hip with no fracture. R1’s dehydration and UTI was treated and resolved while receiving care. Interviews with outside sources confirmed R1 was medically evaluated as needed. Additional interviews by outside sources confirmed R1 was not observed as lacking medical attention during the time in question. There was insufficient evidence to support the allegation facility staff did not seek medical attention in a timely manner.

The Department has investigated the allegations listed above. Based on evidence obtained, including interviews and records reviewed, the above allegations are determined to be unsubstantiated as the Department could not meet the preponderance of the evidence standard. An exit interview was conducted with Paul Richardson and a copy of this report, LIC 811 Confidential Names List and Licensee/Appeals Rights (LIC 9058 01/16) was provided to the Licensee.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Elizabeth Hamilton	TELEPHONE: (619) 929-7590
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022

LIC9099 (FAS) - (06/04)

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