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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603793
Report Date: 08/26/2022
Date Signed: 08/26/2022 12:15:03 PM

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
03/31/2020 and conducted by Evaluator Vicky Williamson
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20200331082518
FACILITY NAME:SUNRISE OF SABRE SPRINGSFACILITY NUMBER:
374603793
ADMINISTRATOR:KLEMP, SHAUNA LYNNFACILITY TYPE:
740
ADDRESS:12515 SPRINGHURST DRTELEPHONE:
(858) 391-9160
CITY:SAN DIEGOSTATE: CAZIP CODE:
92128
CAPACITY:100CENSUS: 81DATE:
08/26/2022
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Kimberly Santillian, Executive Director and Sheliah Sanchez, Resident Care Director TIME COMPLETED:
12:20 PM
ALLEGATION(S):
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Facility staff administered incorrect medication to resident resulting in hospitalization
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Vicky Williamson conducted a complaint visit to deliver findings regarding the above allegation. LPA was greeted by the receptionist and granted entry into the facility. LPA met with Kimberly Santillian, Executive Director (ED) and Sheliah Sanchez, Resident Care Director and discussed the purpose of the visit.

The Department’s investigation consisted of interviews with staff, responsible party, outside sources and review of records to include medical and resident. It was alleged that facility staff administered incorrect medication to resident resulting in hospitalization. It was reported that Resident 1 (R1) [ED was provided an LIC 811 Confidential Names List that identifies the resident] was taken from the facility to the hospital due to an episode of aggression toward a staff and damage to their room and furniture inside of the room. Upon admission to the hospital, R1 was administered a drug test and per toxicology report tested positive for Amphetamines. Per Melissa Martin, Resident Care Director (RCD), R1 was admitted to the facility on 3/11/20, and only left the facility once with a staff member; only visitor visited between 3/11/20 thru 3/29/20.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Vicky WilliamsonTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2022
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-20200331082518
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 OF SABRE SPRINGS
FACILITY NUMBER: 374603793
VISIT DATE: 08/26/2022
NARRATIVE
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RCD was unable to provide the name of the staff member that R1 left the facility with. R1’s only visitor at the facility, was their responsible party. RCD stated that per information received regarding positive toxicology report, R1’s entire room, clothing, furniture, shoes, bathroom and mattress was searched and there, were no medications or substances located.

LPA’s review of R1’s Physician Report revealed R1’s primary diagnosis was Aphasia, Parkinson’s Disease, Dementia, Sick Sinus Syndrome and Restless Leg Syndrome. A review of the Medical Administration Record (MAR) for R1 indicated that all medications for the period of 3/11/20 thru 3/29/20, were administered per physician’s orders.

According to R1’s medical records, it was initially noted that there were no medications that R1 was currently taking that would indicate a positive screen for Amphetamines; however, the discharge notes indicated that medication Selegiline could have possibly caused the positive toxicology report. Medical records also revealed that R1’s medication regiment for the period of 3/29/20 thru 5/11/20 was changed several times during R1’s hospitalization. Per medical record notes, R1’s aggressive behavior toward staff and agitation occurred multiple times throughout their stay at the hospital.

Information received revealed that R1’s responsible party was concerned about medications Selegiline and Lexapro, which R1 was administered after suffering a stroke in 1/31/2020. Their concern was that the reported side effects of these medications are paranoia and aggression.

The Department’s investigation found there is insufficient evidence to determine that facility staff administered incorrect medication to resident resulting in hospitalization. Interviews conducted with staff, responsible party, outside sources, and review of medical and facility records provided no conclusive evidence to support the allegation.

Based on review of records including medical and facility, information from outside sources and interviews conducted, allegation is Unsubstantiated. Although the allegation may have occurred or is valid, there is not a preponderance of the evidence to prove the alleged violation occurred.

An exit interview was conducted with Kimberly Santillian, Executive Director and Sheliah Sanchez, Resident Care Director, the Licensee’s Rights (LIC 9058 01/16), Confidential Names List (dLIC 811) along with a copy of this report was provided to Kimberly Santillian, Executive Director and the signature on this form confirms receipt of these rights.

SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Vicky WilliamsonTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2022
LIC9099 (FAS) - (06/04)
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