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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 455002959
Report Date: 12/12/2024
Date Signed: 12/12/2024 12:43:21 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/21/2024 and conducted by Evaluator Farhaan Sarangi
COMPLAINT CONTROL NUMBER: 59-AS-20241021143944
FACILITY NAME:SUNDIAL ASSISTED LIVINGFACILITY NUMBER:
455002959
ADMINISTRATOR:ELIZABETH AMLINFACILITY TYPE:
740
ADDRESS:395 HILLTOP DRIVETELEPHONE:
(530) 241-2900
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY:65CENSUS: 41DATE:
12/12/2024
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Administrator, Elizabeth AmlinTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Staff stole resident's medication.
INVESTIGATION FINDINGS:
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On December 12, 2024 at approximately 12:00 PM, Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at Sundial Assisted Living for the purpose of delivering complaint findings. LPA was greeted at the door by Administrator, Elizabeth Amlin and was granted access into the facility.

During the course of the investigation, LPA Sarangi reviewed the SOC 341 and LPA Sarah Benson conducted an interview with the Administrator on October 22, 2024. LPA Sarangi interviewed Resident #1 on December 12, 2024.

Complaint alleges that Staff stole resident’s medication. Based on an observation of the SOC 341 that was submitted by the Administrator and the interview with the Administrator, the preponderance of evidence standard has been met. During the investigation, LPA learned that the alleged staff member had her belongings searched with no medication being found. (Report continued on LIC 9099C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
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 59-AS-20241021143944
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 12/12/2024
NARRATIVE
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The Administrator advised that the facility has cameras in common areas including the Medication Room where medications are stored at. As a result, the alleged staff member vacated the position as a Caregiver (See LIC 9099D). LPA educated the Administrator on the importance of ensuring that all staff are competent to provide the services necessary to meet resident needs.

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.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 59-AS-20241021143944
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 12/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/12/2024
Section Cited
CCR
87411(a)
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87411(a) Personnel Requirements - General

(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs......

This requirement was not met as evidenced by:
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Licensee/Administrator should submit an LIC 9098-Self Certification and shall conduct staff training and provide proof of training. In addition, Licensee/Administrator shall provide a statement on how future compliance will be met.
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Based on an interview that was conducted with the Administrator on October 22, 2024, the alleged staff member had her belongings searched with no medication being found which is an immediate health, safety, and personal rights risk to the residents in care.
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POC due on January 2, 2024 due to an extension request.
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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.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3