415600990-4-12-2023-14-AS-KHOS-CQYN5F-20230417100928

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 415600990
Report Date: 04/12/2023
Date Signed: 04/12/2023 02:09:28 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SF COASTAL AC/SC, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/10/2022 and conducted by Evaluator Komal Charitra

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20220110101330

FACILITY NAME:	SUNRISE OF BURLINGAME		FACILITY NUMBER:	415600990
ADMINISTRATOR:	ABBIE APOLINARIO		FACILITY TYPE:	740
ADDRESS:	1818 TROUSDALE DR		TELEPHONE:	(650) 692-2805
CITY:	BURLINGAME	STATE: CA	ZIP CODE:	94010
CAPACITY:	97	CENSUS: 68	DATE:	04/12/2023
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Administrator, Abbie Apolinario		TIME COMPLETED:	02:20 PM

ALLEGATION(S):

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-Facility did not inform resident's physician and responsible party of change in resident's condition
-Facility did not seek resident timely medical attention

INVESTIGATION FINDINGS:

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On April 12, 2023, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced complaint visit to deliver the findings for the above allegations. LPA met with Administrator, Abbie Apolinario and explained the purpose of the visit.

Regarding the allegation, the facility did not inform resident's physician and responsible party of change in resident's condition and facility did not seek resident timely medical attention, according to the reporting party, the facility failed to monitor Resident 1’s (R1’s) rash, allowing it to progress and become worse. In addition, the reporting party states that the facility failed to notify R1’s physician and responsible party and take action until R1 was in severe pain. During the investigation, LPA interviewed the administrator, reviewed R1’s file, and interviewed staff.

According to the Administrator, she denied these allegations and indicated that R1 had an on and off skin rash issue and the facility was in daily communication with R1’s physician regarding the medications being prescribed to R1. In addition, the administrator indicated that updates were also being provided to R1’s physician and responsible party regarding the effectiveness and/or ineffectiveness of the prescribed medications.

Based on file reviewed, LPA reviewed fax communication between the physician and the facility regarding R1’s rashes and any further issues R1 was experiencing. In addition, LPA reviewed facility’s progress notes for R1 and observed any change of condition related to R1’s rash documented as required and reported to all required parties. According to the staff interviewed, when R1's condition worsened or became better, both the physician and the responsible party was notified. In addition, the Administrator and the Assisted Living Coordinator, Antionette Burns indicated that R1's repsonsible party requested the facility to ask permission prior to taking any medical action.

Based on the interviews conducted and information collected, these allegations is deemed to be unsubstantiated meaning although this allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Report is reviewed with Administrator, and a copy is provided with appeal rights.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cara Smith	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Komal Charitra	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023

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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