347004852-9-3-2020-27-AS-MSEY-BT9LXN-20200908090901

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347004852
Report Date: 09/01/2020
Date Signed: 09/03/2020 11:19:55 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/01/2020 and conducted by Evaluator Melana Llopis

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20200701163816

FACILITY NAME:	SUNRIVER SENIOR CARE, LLC.		FACILITY NUMBER:	347004852
ADMINISTRATOR:	DIZON, SUSIE		FACILITY TYPE:	740
ADDRESS:	11229 PECOS RIVER COURT		TELEPHONE:	(916) 853-1925
CITY:	RANCHO CORDOVA	STATE: CA	ZIP CODE:	95670
CAPACITY:	6	CENSUS: 4	DATE:	09/01/2020
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Administrator, Shirely Dizon		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff failed to ensure residents are properly fed
Facility has inadequate record keeping
Staff speak inappropriately towards the residents while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Llopis contacted the facility on 09/01/2020 due to COVID and pre-cautionary measures. LPA spoke with Administrator Shirley Dizon and explained the purpose of the call was to deliver findings for complaint number 27-AS-20200701163816.

Throughout the course of the investigation the Department interviewed staff and residents, virtually toured the physical plant, and reviewed documentation pertinant to the allegations listed above.

Results are as follows:

***Continuation on 9099-C***

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 214-0485
LICENSING EVALUATOR NAME: Melana Llopis	TELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2020

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 27-AS-20200701163816

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: SUNRIVER SENIOR CARE, LLC.	FACILITY NUMBER: 347004852
	VISIT DATE: 09/01/2020

NARRATIVE

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Allegation: Staff failed to ensure residents are properly fed.
On 07/06/2020, 08/20/2020 and 08/21/2020, the Department interviewed staff, residents, and a key witness. Interviews with staff and residents revealed the residents are provided (3) meals a day with two (2) snacks in between. Staff stated they have a suggested menu to follow but will take requests from residents as well. Staff stated there is a sufficient supply of food and grocery shopping is done once a week. Staff stated residents are provided snacks upon request and have not been made aware of any issues with the meals being provided. Residents stated they "enjoy the food" provided by the facility. Residents stated they have made food requests such as "french toast" and the facility provided the meal when asked. The residents stated they like the food and are happy with the meals provided. Key witness stated their loved one has been residing at the facility for a year now and they do not have concerns with the meals or food being provided by the facility. The Department toured the facility on 07/07/2020 and 08/14/2020 and found there was a sufficient supply of perishables and non-perishable food items. Receipt records reviewed show the facility made weekly grocery store purchases in the last three months prior to the investigation. Facility menu reveals three (3) meals are provided with two (2) snack in between. No evidence was provided to indicate the validity of the allegation above.

Allegation: Facility has inadequate record keeping.
On 08/12/2020, LPA reviewed the following documents: Staff CPR and First Aid certificates, continued education training certificates, and resident records for four (4) of four (4) residents in care. Records reviewed indicate the facility staff have current CPR and first aid certificates. Companies who supplied certification appear to be valid and legitimate based on LPA research. No counterfeit documents were provided as alleged. Resident records reviewed show records are current and complete. Interviews with staff stated they have received legitimate training and certification.

Allegation: Staff speak inappropriately towards the residents while in care.
On 08/21/2020, the Department interviewed four (4) of four (4) residents in care. Residents stated they "like it" at the facility, the staff treat them "fine and are friendly," and the place is "so calm." Residents stated they did not have any complaints with the staff or their care. On 08/21/2020, the Department also interviewed a key witness who stated the staff are "empathetic and sweet," and the facility is "heaven compared to the last facility." No evidence was provided to indicate the validity of the allegation above.

Based on interviews and records reviewed the Department finds the allegations to be UNFOUNDED, meaning there was not a preponderance of evidence that the events occurred.

No deficiencies are being cited as a result of today's call.

Exit interview conducted via telephone, copy of report provided via email. The facility will print, sign, and send a signed copy of report to CCL.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 214-0485
LICENSING EVALUATOR NAME: Melana Llopis	TELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2020

LIC9099 (FAS) - (06/04)

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