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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 455002959
Report Date: 01/07/2025
Date Signed: 01/07/2025 12:55:41 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
01/02/2025 and conducted by Evaluator Farhaan Sarangi
COMPLAINT CONTROL NUMBER: 59-AS-20250102142045
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: 39DATE:
01/07/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator, Elizabeth AmlinTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Staff did not administer medication as prescribed.
INVESTIGATION FINDINGS:
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On January 7, 2025 at approximately 09:30 AM, Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at Sundial Assisted Living for the purpose of conducting a complaint investigation inspection. 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 conducted interviews with staff, residents and a witness. LPA reviewed resident records and facility records.

Complaint alleges that Staff did not administer medication as prescribed. Based on observation of the Medication Administration Record (MAR) conducted on January 7, 2025, LPA observed Resident #1 not receiving a dosage of medication on December 31, 2024 (See LIC 9099D). LPA conducted interviews with staff members and learned that a medication dosage was missed and documented on the Medication Administration Record (MAR). (Report continued on LIC 9099C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025
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 5
Control Number 59-AS-20250102142045
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: 01/07/2025
NARRATIVE
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LPA educated the Administrator and the Resident Care Director on the importance of ensuring that ALL residents are having their respective medications administered as outlined in the Medication Orders and Title 22 Regulation.

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 emailed to the Administrator along with Appeal Rights.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5
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
01/02/2025 and conducted by Evaluator Farhaan Sarangi
COMPLAINT CONTROL NUMBER: 59-AS-20250102142045

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: 39DATE:
01/07/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator, Elizabeth AmlinTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Staff did not prevent residents from having multiple falls while in care.
Facility is not adequately staffed to meet the needs of the residents in care.
INVESTIGATION FINDINGS:
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On January 7, 2025 at approximately 09:30 AM, Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at Sundial Assisted Living for the purpose of conducting a complaint investigation inspection. 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 conducted interviews with staff, residents and a witness. LPA reviewed resident records and facility records.

Complaint alleges that Staff did not prevent residents from having multiple falls while in care. Based on interviews that were conducted, LPA could not prove or disprove the allegation. LPA conducted interviews with residents and staff, LPA received inconsistent statements as it relates to the time it took for the resident to be picked up from the floor. Furthermore, during interviewing, LPA learned that the resident did not secure the call pendent appropriately to the neck and was unable to call for help during the incident in question. (Report continued on LIC 9099C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 59-AS-20250102142045
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: 01/07/2025
NARRATIVE
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Complaint alleges that Facility is not adequately staffed to meet the needs of the residents in care. Based on observation, tour of the facility conducted on January 7, 2025 and interviews that were conducted, LPA could not corroborate the allegation. Furthermore, a review of the LIC 500 revealed sufficient staffing. During a tour of the facility conducted on said date, LPA observed sufficient staffing in place providing care and supervision to the resident population. LPA interviewed the Administrator and was advised that the facility has identified a staffing agency in case that the facility suffers through a staffing issue. During interviews with a sample of residents, LPA received inconsistent statements as it relates to the allegation.

A finding that the complaint allegations of Staff did not prevent residents from having multiple falls while in care. Facility is not adequately staffed to meet the needs of the residents in care are unsubstantiated meaning that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview was conducted and a copy of this was report was signed and emailed to the Administrator.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 59-AS-20250102142045
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: 01/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/14/2025
Section Cited
CCR
87465(c)(2)
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87465(c)(2) Incidental Medical and Dental Care:

(c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met:

(2) Once ordered by the physician the medication is given according to the physician's directions.

This requirement was not met as evidenced by:
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Licensee/Administrator shall fill out an LIC 9098 understanding of the regulation. Furthermore, LPA requested the facility to conduct staff training by an outside agency to train on medication management, documentation and administration of medications to residents served.
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Based on an observation of the Medication Administration Record, LPA observed that facility staff missed a dosage of medication that was supposed to be administered to the resident in care which is a potential health, safety, and personal rights risk to the residents in care.
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In addition, LPA requested the facility to provide proof of training and a statement on how future compliance will be met.

POC Due date: February 7, 2025.
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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: 01/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5