306004562-10-7-2020-22-AS-AORZ-BUBW3A-20201012165538

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004562
Report Date: 10/07/2020
Date Signed: 10/07/2020 02:24:04 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/05/2020 and conducted by Evaluator Rosie Quiroz

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200205161415

FACILITY NAME:	SUNRISE OF SEAL BEACH		FACILITY NUMBER:	306004562
ADMINISTRATOR:	LUIS RODRIGUEZ		FACILITY TYPE:	740
ADDRESS:	3850 & 3840 LAMPSON AVE		TELEPHONE:	(562) 594-5788
CITY:	SEAL BEACH	STATE: CA	ZIP CODE:	90740
CAPACITY:	261	CENSUS: 147	DATE:	10/07/2020
		UNANNOUNCED	TIME BEGAN:	01:36 PM
MET WITH:	Luis Rodriguez, Administrator		TIME COMPLETED:	02:10 PM

ALLEGATION(S):

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-Facility is not adequately staffed to meet the needs of residents in care
-Facility staff did not inform resident's authorized representative of fall in a timely manner

INVESTIGATION FINDINGS:

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On today's date, Licensing Program Analyst (LPA) Rosie Quiroz contacted the facility for the purpose to deliver findings for a complaint investigation via telephone due to COVID-19 and pre-cautionary measures.
The initial 10-day visit was completed on 2/14/2020. During the initial 10 day visit, LPA Quiroz obtained copies of Resident’s (R1’s) Physician’s Report, R1's care plan, Resident Roster, Staff Roster and Staff Schedules for December 2019-February 2020, R1's progress notes from 5/14/2018-1/30/2020. R1's Order Summary report, R1's Residential Agreement and Care plans for Resident 2 (R2), Resident 3(R3), Resident 4 (R4), Resident 5 (R5), Resident 6 (R6) and Resident 7 (R7), and laundry schedule for R1.
It was alleged that "Facility is not adequately staffed." During the course of this investigation, LPA Quiroz conducted multiple interviews with interviewees, reviewed documents including but not limited to staff schedules, resident care plans and observations during unannounced tour inspection on 2/14/2020.
CONTINUED ON NEXT PAGE...

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie Quiroz	TELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2020

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20200205161415

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: SUNRISE OF SEAL BEACH	FACILITY NUMBER: 306004562
	VISIT DATE: 10/07/2020

NARRATIVE

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During unannounced inspection tour on 2/14/2020, LPA Quiroz observed four care managers, one lead care manager, one life enrichment manager, one Licensed Vocational Nurse and one housekeeper on the Reminiscence unit to a ratio of 36 residents present on the Reminiscence unit during inspection tour.
LPA Quiroz was informed by lead care manager that an additional care manager was out to lunch during inspection tour. Twelve of twelve Interviewees denied allegations that "Facility is not adequately staffed."
Staff indicated that they all work as a team, and no staff is overwhelmed with heavier work load and that they help out each other. Staff reported they are not at full census capacity on the Reminiscence Unit, and are averaging approximately 6 residents per care manager. Administrator reported that since he came on board, he conducted mass hiring and "is making sure there is always a lead care manager on every shift, one a life enrichment manager, 6 care managers, an LVN and 1 housekeeper on the floor at all times." LPA Quiroz reviewed facility staff schedules for December 2019-February 2020, which reflects the following staffing on the Reminiscence Unit/ memory care unit: AM- 6 caregivers, and 1 lead caregiver total of 7 staff, PM-6 caregivers, and 1 lead caregiver total of 7 staff, NOC SHIFT-2 caregivers, and 1 lead caregiver total of 3 staff in addition to one LVN and housekeeper. LPA Quiroz was unable to corroborate the above allegation. Based on a review of the above information, observations and interviews conducted, we have found the complaint allegation of "Facility is not adequately staffed" is UNFOUNDED, meaning that the allegation was false, could not have happened or is without a reasonable basis. We have therefore dismissed the complaint.

It was alleged that "Facility staff did not inform resident's authorized representative of fall in a timely manner."
During the course of this investigation, LPA Quiroz conducted multiple interviews with interviewees, reviewed documents including but not limited to R1's physician report dated 10/4/2018, R1's care plan, and progress notes from 5/14/2018-1/30/2020. During interviews conducted it was reported that on 1/29/2020 reporting party received a call four hours after the fact. The investigation reveled that there were 7 incidents which required notification to resident's responsible party between the dates 5/14/2018-1/30/2020. Documentation and interviews conducted with interviewees revealed that proper notifications were made timely according to Residential Agreement Page 1 of 37 under NOTIFICATION OF THIRD PARTIES: In the event that the resident requires emergency services or experiences a significant change in condition, the community will attempt to contact the responsible party or other individual designated by the resident, within twelve (12) hours. The resident is responsible for ensuring that the community has current telephone numbers for the individuals to to be notified.
CONTINUED ON NEXT PAGE... ***This is an amended report***

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie Quiroz	TELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2020

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20200205161415

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: SUNRISE OF SEAL BEACH	FACILITY NUMBER: 306004562
	VISIT DATE: 10/07/2020

NARRATIVE

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Based on a review of the above information, observations and interviews conducted, we have found the complaint allegation of "Facility staff did not inform resident's authorized representative in a timely manner" is UNFOUNDED, meaning that the allegation was false, could not have happened or is without a reasonable basis. We have therefore dismissed the complaint.

An exit interview was conducted with Administrator, Luis Rodriguez via telephone and a copy of this report was provided via email. An electronic email read receipt, confirms receiving these documents. Administrator agreed to receive the copies of the report and to return a signed copy to Community Care Licensing and LPA Quiroz timely.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie Quiroz	TELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2020

LIC9099 (FAS) - (06/04)

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