455002959-9-9-2024-59-AS-FSAI-D8XSSK-20240909140805

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 455002959
Report Date: 09/09/2024
Date Signed: 09/09/2024 02:09:22 PM

Document Has Been Signed on 09/09/2024 02:09 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	SUNDIAL ASSISTED LIVING		FACILITY NUMBER:	455002959
ADMINISTRATOR:	ELIZABETH AMLIN		FACILITY TYPE:	740
ADDRESS:	395 HILLTOP DRIVE		TELEPHONE:	(530) 241-2900
CITY:	REDDING	STATE: CA	ZIP CODE:	96003
CAPACITY:	65	CENSUS: 41	DATE:	09/09/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Administrator, Elizabeth Amlin		TIME COMPLETED:	02:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On September 9, 2024 at approximately 11:30 AM, Licensing Program Analyst (LPA), Farhaan Sarangi met with Administrator, Elizabeth Amlin for the purpose of conducting a Required 1 year inspection. LPA and Administrator toured the facility. LPA observed the facility to be clean and at a comfortable temperature with all exits free from obstruction. Fire Extinguisher was found to be last charged on March 2024 at the time of the inspection. All smoke detectors sound directly to the fire station. Water temperature in facility bathroom measured at 108 degrees, within acceptable range of 105 to 120 degrees F. LPA observed sufficient perishable and non-perishable foods located in the kitchen. There are special provisions made for individuals with special dietary needs. Food menu was presently available for viewing during the inspection. Medications were centrally stored and locked. Cleaning products and other toxins are located in the laundry room that was locked and inaccessible to residents in care. There was a supply of linens, cleaners, hygiene products and paper products available for residents. All bathrooms designated for residents in the common areas at the facility were supplied with individual paper towels and hand soap. Bathrooms in resident’s rooms have a towel and soap. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present. A tour of vacant and occupied bedrooms were conducted, and bedrooms inspected have lighting and appropriate furnishing. LPA advised facility to contact County Public Health and Community Care Licensing immediately if symptoms of COVID-19 or other infectious diseases are present in the facility. LPA was made aware that the Facility Infection Control Plan is currently being updated. (See LIC 9102-Technical Advisory) First Aid kit was inspected and found to be appropriate during the inspection. Emergency Disaster Drill was last conducted in July 2024. LPA reviewed 5 of 5 resident files. However, during the medication review, LPA observed that 2 out of 5 residents did not have their prescribed medication (See LIC 809D). When LPA inquired about the medications, staff did not know if the medication has been discontinued or not. (Report continued on LIC 809C)

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 202-0832
LICENSING EVALUATOR NAME: Farhaan Sarangi	TELEPHONE: (916) 307-0474
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SUNDIAL ASSISTED LIVING	FACILITY NUMBER: 455002959
	VISIT DATE: 09/09/2024

NARRATIVE

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LPA educated the Administrator on the importance of ensuring that all medications are afforded to the residents. LPA reviewed staff files and found those files to be appropriate during the review. LPA requested the following documents to be sent:

LIC 500- Personnel Report
LIC 308- Designation of Facility Responsibility
LIC 309- Administrative Organization
Most up-to-date Liability insurance
Emergency Disaster Plan
Control of Property
Register of residents
Most updated Infection Control Plan
Most recent Fire Inspection Report

Deficiencies cited from the California Code of Regulations, Title 22, Division 6, Chapter 8 of California Regulation. Appeal rights were provided. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties. Exit interview was conducted, and a copy of this report was signed and given to the Administrator along with Appeal Rights.

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 202-0832
LICENSING EVALUATOR NAME: Farhaan Sarangi	TELEPHONE: (916) 307-0474
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2024

LIC809 (FAS) - (06/04)

Page: 2 of 4

Document Has Been Signed on 09/09/2024 02:09 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SUNDIAL ASSISTED LIVING	FACILITY NUMBER: 455002959
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/09/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87465(a)(6)

Incidental Medical and Dental Care Services

(6) When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above in 2 out of 5 residents did not have their prescribed medications secured in the cart. Facility staff does not know if the medications have been discontinued or not. This regulation poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/16/2024
	Plan of Correction
1 2 3 4	POC shall include a statement on how future compliance will be met. Submit an LIC 9098-Self Certification and conduct staff training.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Lauren Crocker	TELEPHONE: (916) 202-0832
LICENSING EVALUATOR NAME: Farhaan Sarangi	TELEPHONE: (916) 307-0474
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2024

LIC809 (FAS) - (06/04)

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