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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415601114
Report Date: 05/03/2023
Date Signed: 05/03/2023 03:55:15 PM


Document Has Been Signed on 05/03/2023 03:55 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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



FACILITY NAME:SUNRISE OF REDWOOD CITYFACILITY NUMBER:
415601114
ADMINISTRATOR:LAYANA SANTOSFACILITY TYPE:
740
ADDRESS:1 EAST SELBY LANETELEPHONE:
(650) 885-7992
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94063
CAPACITY:127CENSUS: 41DATE:
05/03/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Jennifer BruhnTIME COMPLETED:
04:00 PM
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On this day Licensing Program Analyst (LPA) conducted an unannounced case management visit in regards to missing narcotics. LPA met with interim administrator Jennifer Bruhn and explained the purpose of today's visit. Health care manager Jo Marie Ghersi attended the meeting as well to discuss the missing narcotics.

It was reported to the Department on 05/01/2023 that over the weekend during routine medication check the Health care manager Jo Marie Ghersi was conducting an audit and discovered the missing narcotics beginning on 04/29/2023 and then again on 04/30/2023. According to Jo the final count of missing narcotics that were prescribed as needed. The facility did report accordingly to the Department on 05/01/2023 and followed with an incident report on 05/02/2023. The facility reported the loss to local Sheriff's Department and was provided a file number for the incident. The facility is actively investigating the situation which included additional medication audits, reviewing the medication administration records, as well as actively looking into their own staff. There is a discrepancy found by the health care manager regarding the crossover signatures on the days in question as being incomplete. The medications are accurately documented on the centrally stored medication log and for each resident. The narcotics are triple locked in the appropriate area of the medication room to ensure the are inaccessible to residents in care. The only persons with access are the staff. Residents' whose medication is missing did not miss any dosage of medication and the facility is replacing those missing items as necessary. Investigation into the matter is ongoing at this time.

No citations at this time as this investigation is ongoing.

Report is reviewed with interim administrator Jennifer Bruhn.
SUPERVISOR'S NAME: Cara SmithTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jaime VadoTELEPHONE: (559) 476-9353
LICENSING EVALUATOR SIGNATURE:
DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/03/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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