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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 397002740
Report Date: 11/05/2021
Date Signed: 11/05/2021 04:26:54 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/20/2021 and conducted by Evaluator Ashley Boothe
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20210720113955
FACILITY NAME:SUNRISE HOMESFACILITY NUMBER:
397002740
ADMINISTRATOR:ELIZABETH ABESAFACILITY TYPE:
740
ADDRESS:8100 S. BRIGHT ROADTELEPHONE:
(209) 234-2550
CITY:FRENCH CAMPSTATE: CAZIP CODE:
95231
CAPACITY:15CENSUS: 10DATE:
11/05/2021
UNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Elizabeth AbesaTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Facility is cashing resident's checks after declining resident to return to facility.
INVESTIGATION FINDINGS:
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On 11/5/2021 at 3:45pm Licensing Program Analyst (LPA) Ashley Boothe arrived to deliver an amendment of complaint investigation findings with the following allegations: Facility is cashing resident's checks after declining resident to return to facility. LPA met with Administrator and stated the purpose of the visit. Today's Census 10. The complaint findings have changes and this 9099 supercedes complaint findings LPA delivered to Administrtor on 8/17/2021.

During the course of the investigation the Department reviewed records, conducted interviews and on site inspection. In March, Resident one (R1) experienced a medical emergency and was transported to hospital. Administrator informed ER R1 required an increased level of care which the facility could not provide. Upon discharge R1 was admitted to a skilled nursing facility (SNF) for rehabilitation. Upon admission SNF notes Administrator stated that R1 needed a long-term care facility and the facility was not able to care fore R1’s needs. Administrator expressed that if R1 improved Administrator would return to reassess R1 for return to facility.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Ashley BootheTELEPHONE: (916) 708-7751
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 27-AS-20210720113955
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: SUNRISE HOMES
FACILITY NUMBER: 397002740
VISIT DATE: 11/05/2021
NARRATIVE
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Administrator did not reappraise R1 and R1 did not return to the facility. Administrator did not notify R1’s payee of R1’s transfer to hospital or SNF. Administrator continued to collect and cash R1’s rent and personal spending checks from R1’s payee through June 2021 while R1 was not residing in the facility and no services or care were provided to R1 without documenting a reappraisal to determine if R1’s level of care need could be met by the facility.

Based on information obtained the aforementioned allegation is SUBSTANTIATED. A finding that the complaint is substantiated means the preponderance of evidence standard has been met, therefore the allegation is found to be substantiated.

Per California Code of Regulations (CCRs) - Title 22, Division 8, the following deficiencies are being cited on the attached 9099D during this visit. A copy of their rights (LIC9058) provided and a signature on this form acknowledges receipt of these rights. Exit interview held and a copy of report provided.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Ashley BootheTELEPHONE: (916) 708-7751
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20210720113955
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: SUNRISE HOMES
FACILITY NUMBER: 397002740
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/05/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
11/19/2021
Section Cited
CCR
87463(b)
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Reappraisals (b) The licensee shall immediately bring any such changes to the attention of the resident's physician and his family or responsible person.
This requirement is not met as evidence by:
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The Licensee agrees to submit a written declaration to maintain compliance with this regulation at all times to LPA by POC due date.
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Based on observation, interview and record review the Licensee did not comply with the section cited above in that administrator did not reappraise in writing R1 at hospital or SNF to determine R1 care level needs and notify R1's payee of change in condition which poses an potential health, safety, and personal rights risk to residents in care.
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Request Denied
Type B
11/19/2021
Section Cited
CCR
87217(a)
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Safeguards for Resident Cash, Personal Property, and Valuables (a) … a resident incapable of handling his own cash resources, as documented by the initial or subsequent appraisal, … cash resource shall be safeguarded in accordance with the regulations in this section.
This requirement is not met as evidence by:
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The Licensee agrees to submit a written declaration to maintain compliance with this regulation at all times to LPA by POC due date.
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Based on observation, interview and record review the Licensee did not comply with the section cited above in that the Licensee did not safeguard R1’s monies by cashing checks without reappraising R1 and did not notify R1’s payee of R1’s no longer in the facility which poses a potential health, safety, and personal rights risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Ashley BootheTELEPHONE: (916) 708-7751
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3