<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 455002959
Report Date: 09/19/2024
Date Signed: 09/19/2024 10:50:42 AM

Unsubstantiated


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
08/22/2024 and conducted by Evaluator Farhaan Sarangi
COMPLAINT CONTROL NUMBER: 59-AS-20240822111039
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: 40DATE:
09/19/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator, Elizabeth AmlinTIME COMPLETED:
11:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Residents are not being changed in a timely manner
Resident are not receiving enough hydration
Staff are doing finger sticks to check blood sugars
Medications have been charted as given, but have not been
Narcotics have been missing
Staff do not check on resident's oxygen equipment at night, putting her at risk
Staff did not refill resident’s medication prescription
Staff was tested covid positive.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On September 19, 2024 at approximately 09:30 AM, 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 reviewed facility records, resident records, interviewed staff, a former staff member and residents in care. LPA toured the facility on August 27, 2024, and September 9, 2024.

Complaint alleges that residents are not being changed in a timely manner. Based on interviews that were conducted with Resident #1, LPA learned of no concerns as it relates to the allegation. Furthermore, LPA received inconsistent statements and could not corroborate the allegation.

(Report continued on LIC 9099C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 202-0832
LICENSING EVALUATOR NAME: Farhaan SarangiTELEPHONE: (916) 307-0474
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024
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 7
Control Number 59-AS-20240822111039
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: 09/19/2024
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
26
27
28
29
30
31
32
Complaint alleges that Resident are not receiving enough hydration. Based on interviews and observations that were conducted throughout the course of the investigation, LPA could not corroborate the allegation. Furthermore, LPA interviewed Resident #1 and learned that staff are attentive to the needs of the resident, and that the residents get plenty of food and water at the facility.

Complaint alleges Staff are doing finger sticks to check blood sugars. Based on interviews that were conducted, LPA received inconsistent statements as it relates to the allegation. LPA learned that residents are assisted with checking of blood sugars which was confirmed by interviews with Former Staff Member #1, and the current Administrator of the facility.

Complaint alleges that Medications have been charted as given but have not been. Based on observations of the Medication Administration Record (MAR) on August 27, 2024, LPA observed that medications have been charted appropriately. Furthermore, LPA did not have sufficient evidence to corroborate the allegation.

Complaint alleges that Narcotics have been missing. Based on an interview that was conducted with Witness #1, LPA learned that a narcotic was missing on August 8, 2024, and documented in the Hospice Nurses Notes. However, the narcotics medications were found by the facility and not missing. On August 27, 2024, during the opening of the complaint, LPA reviewed the Medication Administration Record (MAR) for Resident #3 and observed the medication in question to be available, secured, and locked. LPA did not have sufficient evidence to corroborate the allegation.

Complaint alleges that Staff do not check on resident's oxygen equipment at night, putting her at risk. Based on interviews that were conducted, LPA received inconsistent statements as it relates to the allegation. Furthermore, LPA could not corroborate the allegation.

Complaint alleges that Staff did not refill resident’s medication prescription. Based on observations and interviews, LPA reviewed the Medication Administration Record (MAR) for Resident #1, #2 and #3 on August 27, 2024, and did not observe any concerns. LPA conducted interviews and received inconsistent statements during the interviews. LPA did not have sufficient evidence to corroborate the allegation.

(Report continued on LIC 9099C)
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 202-0832
LICENSING EVALUATOR NAME: Farhaan SarangiTELEPHONE: (916) 307-0474
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 59-AS-20240822111039
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: 09/19/2024
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
26
27
28
29
30
31
32
Complaint alleges that staff was tested covid positive. Based on interviews that were conducted, LPA learned that the facility followed their respective Infection Control Plan and kept the staff member at home. Furthermore, LPA received inconsistent statements as it relates to the allegation. LPA did not have sufficient evidence to corroborate the allegation.

A finding that the complaint allegations of Residents are not being changed in a timely manner, Resident are not receiving enough hydration, Staff are doing finger sticks to check blood sugars, Medications have been charted as given, but have not been, Narcotics have been missing, Staff do not check on resident's oxygen equipment at night, putting her at risk, Staff did not refill resident’s medication prescription, Staff was tested covid positive 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 given to the Administrator.
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 202-0832
LICENSING EVALUATOR NAME: Farhaan SarangiTELEPHONE: (916) 307-0474
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 7
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
08/22/2024 and conducted by Evaluator Farhaan Sarangi
COMPLAINT CONTROL NUMBER: 59-AS-20240822111039

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: 40DATE:
09/19/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator, Elizabeth AmlinTIME COMPLETED:
11:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is not properly reporting incidents
Resident left on commode for long periods of time.
Staff did not charge resident’s oxygen tank.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On September 19, 2024 at approximately 09:30 AM, 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 reviewed facility records, resident records, interviewed staff, a former staff member and residents in care. LPA toured the facility on August 27, 2024, and September 9, 2024.

Complaint alleges that Facility is not properly reporting incidents. Based on interviews that were conducted on August 27, 2024, with the Administrator, LPA learned that there were incident reports regarding residents’ health that was not reported to Community Care Licensing Division (CCLD) (See LIC 9099D). LPA educated the Administrator on the importance of ensuring that all reportable incidents are reported to CCLD in a timely manner. (Report continued on LIC 9099C)
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 202-0832
LICENSING EVALUATOR NAME: Farhaan SarangiTELEPHONE: (916) 307-0474
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 59-AS-20240822111039
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: 09/19/2024
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
26
27
28
29
30
31
32
Complaint alleges that Resident left on commode for long periods of time. Based on interviews that were conducted on August 27, 2024 with the Administrator, LPA learned that the former staff member accidentally left the resident on the commode for approximately 20 minutes. During an interview with the former staff member on September 12, 2024, at approximately 12:00 PM, LPA learned that the resident was left on the commode for 15 minutes. Former Staff Member was able to acknowledge this incident and was apologetic to the facility Administrator and to the LPA (See LIC 9099D).

Complaint alleges that Staff did not charge resident’s oxygen tank. Based on interviews that were conducted with the Administrator on August 27, 2024, LPA learned that the resident’s oxygen tank was not plugged in all the way which subsequently led to the oxygen not dispensing to the resident (See LIC 9099D). LPA educated the Administrator on the importance of ensuring that all oxygen devices are functioning and operating normally.

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 additional 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 CrockerTELEPHONE: (916) 202-0832
LICENSING EVALUATOR NAME: Farhaan SarangiTELEPHONE: (916) 307-0474
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 59-AS-20240822111039
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: 09/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/26/2024
Section Cited
CCR
87211(a)(1)(d)
1
2
3
4
5
6
7
87211(a)(1)(d) Reporting Requirements

(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following:

(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case.

(D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident.

This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Licensee/Administrator to submit an LIC 9098 understanding of the regulation. In addition, Licensee and Administrator shall conduct staff training outlining Reporting Requirements. Licensee/Administrator shall provide a statement on how future compliance will be met.
8
9
10
11
12
13
14
Based on interviews that were conducted on August 27, 2024, LPA learned that there were incident reports regarding residents’ health that was not reported to Community Care Licensing Division (CCLD) which presents a potential health, safety and personal rights risk to the residents in care.
8
9
10
11
12
13
14
POC due date: September 26, 2024
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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 CrockerTELEPHONE: (916) 202-0832
LICENSING EVALUATOR NAME: Farhaan SarangiTELEPHONE: (916) 307-0474
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 59-AS-20240822111039
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: 09/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/20/2024
Section Cited
CCR
87466
1
2
3
4
5
6
7
87466 Observation of the Resident

The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs…

This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Licensee/Administrator to submit an LIC 9098 understanding of the regulation. In addition, Licensee and Administrator shall conduct staff training outlining Observing the resident and documenting any changes. Licensee/Administrator shall provide a statement on how future compliance will be met.
8
9
10
11
12
13
14
Based on interviews that were conducted, LPA learned that a resident was left on the commode for a long period of time which presents an immediate health, safety and personal rights risk to the residents in care.
8
9
10
11
12
13
14
POC due date: September 20, 2024
Type A
09/20/2024
Section Cited
CCR
87618(b)(3)(h)
1
2
3
4
5
6
7
87618(b)(3)(h) Oxygen Administration - Gas and Liquid

(b) In addition to Section 87611(b), the licensee shall be responsible for the following:

(3) Ensuring that the use of oxygen equipment meets the following requirements:

(H) Equipment shall be operable.

This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Licensee/Administrator to submit an LIC 9098 understanding of the regulation. In addition, Licensee and Administrator shall conduct staff training outlining Oxygen Administration. Licensee/Administrator shall provide a statement on how future compliance will be met.
8
9
10
11
12
13
14
Based on interviews that were conducted, LPA learned that the facility did not plug in the portable oxygen tank all the way which presents an immediate health, safety and personal rights risk to the residents in care.
8
9
10
11
12
13
14
POC due date: September 20, 2024
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 CrockerTELEPHONE: (916) 202-0832
LICENSING EVALUATOR NAME: Farhaan SarangiTELEPHONE: (916) 307-0474
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024
LIC9099 (FAS) - (06/04)
Page: 7 of 7