374603395-7-11-2024-08-AS-JLOT-D8N7AS-20240830213000

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603395
Report Date: 07/11/2024
Date Signed: 07/11/2024 06:21:19 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 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
05/14/2021 and conducted by Evaluator Debbie Correia

COMPLAINT CONTROL NUMBER: 08-AS-20210514152341

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: 55	DATE:	07/11/2024
		UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Executive Director (ED) Meg Franz		TIME COMPLETED:	03:25 PM

ALLEGATION(S):

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Facility not addressing pest infestation.
Staff not meeting resident needs.
Facility in disrepair.
Staff did not notify POA of rate change.
Staff did not safeguard residents personal belongings.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Correia conducted an unannounced visit to deliver investigative findings on the above-mentioned allegations. LPA identified herself and discussed the purpose of the visit with Executive Director (ED) Franz.

The Department’s investigation consisted of resident, staff, outside source interviews, resident records review, and a facility tour.

It was alleged the facility did not address a pest infestation. An interview with Outside Source 1 (OS1) revealed the facility had pests, the interview also revealed facility staff have had a pest control agency come treat the facility however OS1 still saw them at the facility. An interview conducted with facility Staff 1 (S1) revealed the facility is contracted with a pest control agency that serviced the property monthly.

[Continued on LIC 9099C]

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jennifer Lott	TELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Debbie Correia	TELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2024

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-20210514152341

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: SUNRISE ASSISTED LIVING AT LA JOLLA	FACILITY NUMBER: 374603395
	VISIT DATE: 07/11/2024

NARRATIVE

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Additionally, it was alleged that the facility did not notify R1 and R2's Power of Attorney (POA) of changes in condition. Resident records reviews revealed both R1 and R2 were admitted to the facility on August 27, 2020. Records also revealed at admission R1's primary diagnosis was Dementia and required a high level of care, there were no available records regarding R1 had experienced a change in condition to support the allegation. A review of available records revealed R2 was admitted to the facility with a primary diagnosis of Cardiomyopathy and a seizure disorder and required a high level of care. Similarly, R2 did not have available records regarding a change in condition to support the allegation.

Lastly, it was alleged facility staff did not safeguard residents personal belongings. An outside source alleged R1's toothbrush had gone missing. A resident records review revealed no evidence of R1 missing a toothbrush. Interviews conducted with residents revealed never have had any missing items while at the facility.[See LIC 811 for confidential names]

Due to lack of corroborating evidence, the finding regarding the above allegations were established to be unsubstantiated. This finding means although the allegations may have happened or could be valid, there is not a preponderance of evidence to prove that the alleged violations occurred.

LPA Correia conducted an exit interview with ED Franz. At the time of the exit interview ED Franz was advised a copy of the Complaint Investigation Report (LIC9099) and Licensee Rights (LIC9058 01-2016) will be provided and signature on this report acknowledges receipt of the rights.

SUPERVISOR'S NAME: Jennifer Lott	TELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Debbie Correia	TELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2024

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20210514152341

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: SUNRISE ASSISTED LIVING AT LA JOLLA	FACILITY NUMBER: 374603395
	VISIT DATE: 07/11/2024

NARRATIVE

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A facility records review revealed the last inspection was conducted on May 11, 2021. Interviews conducted with Residents in care revealed no issues with pests at the facility. During a facility tour LPA observed no signs of a pest infestation.

It was alleged staff was not meeting resident’s needs. On May 14, 2021, Outside Source 1 (OS1) alleged Resident’s 1 (R1’s) toilet was not being checked and was observed not being flushed. A review of R1's records dated May 21, 2021, revealed R1 was incontinent, wore briefs, and was receiving incontinence care by facility staff with no corroborating documentation of issues with R1's toilet or plumbing. At the time of the follow-up visit additional records were not available for review. It was also alleged Resident 2 (R2) was not being provided assistance with bathing, and their briefs were not fastened on properly. A review of Resident 2 (R2) records dated also May 21, 2021, revealed their care plan consisted of assistance with bathing one day a week, there was no corroborating evidence of R2 not receiving assistance with bathing by facility staff. At the time of the follow-up visit additional records were not available for review. Interviews conducted with residents in care revealed no issues with their needs being met. Specifically, one resident interview revealed they have lived at the facility for approximately 16 years and have never had any issues with their needs being met, the interview also revealed the facility staff were very good about providing care and felt the care and cleaning services were great.

It was alleged the facility is in disrepair. During a facility tour LPA observed the facility to be well kempt. LPA observed the bathroom fixtures, including toilets, lighting, and sinks were all operational and in good condition. Interviews conducted with residents revealed no issues with the physical plant regarding disrepair and revealed the facility has on-site maintenance that had been very good to address any issues at the facility. An interview conducted with facility Staff 1 (S1) corroborated the facility has on-site maintenance and that there is a tracking log of work orders for documentation purposes housed at the facility. A facility records review revealed several completed work orders that addressed plumbing issues in a timely manner.

[Continued on LIC 9099C]

SUPERVISOR'S NAME: Jennifer Lott	TELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Debbie Correia	TELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2024

LIC9099 (FAS) - (06/04)

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