Sunrise of Mission Viejo

Allegation investigated: Staff did not monitor the resident's health changes.

Licensing Program Analyst (LPA) Jessica Cho arrived unannounced for the purpose to deliver the findings into the above allegation. LPA stated the purpose of the visit to Executive Director (ED) Maria Domingo and reviewed the allegation. On August 4, 2023, LPA initiated the complaint investigation visit. Interviews were conducted with residents and staff, and LPA obtained copies of pertinent resident records. The following was revealed during the course of the investigation: It is alleged that the staff did not monitor the resident’s health changes. Resident #1 (R1) was admitted to the facility on August 6, 2022. On August 27, 2022, R1 was hospitalized due to a behavioral episode and was diagnosed with Hypocalcemia. Upon review of the Physician's Move In Orders/Prescriptions dated August 3, 2022, it was determined that R1’s primary care physician did not prescribe R1 calcium upon admission to the facility; and as result, causing R1 to exhibit severe symptoms. It was confirmed with four out of four individuals whom have indicated that R1’s attending physician is/was not employed or affiliated with the facility. Unfounded Additionally, seven out of the eight residents expressed that their change of condition was continuously monitored by the facility staff and was not concerned about their care. One resident refused to participate in the interview. Therefore, this agency has investigated the complaint and based on the interviews which were conducted and the records that were reviewed, the allegation: Staff did not monitor the resident’s health changes is deemed UNFOUNDED. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint. An exit interview was conducted with Executive Director Maria Domingo, and a copy of this report was emailed to the Executive Director at the end of the visit.the state’s words, verbatim · CDSS document, Sep 7, 2023 · control 22-AS-20230802084533

Type of visit: Case Management - Incident

This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of following up on construction plans for renovating the kitchen floor submitted to the Orange County Regional Office (OCRO) on 06/27/23. LPA met with Administrator (AD) Maria Domingo and explained the purpose of the inspection. During the first inspection on 07/03/23, LPA inspected the facility and reviewed the facility’s plans for the kitchen floor renovation. Per AD, the kitchen floor renovation project was completed on 08/11/23, there were no issues related to the project, and the facility returned to normal kitchen operations. During today’s inspection, LPA and AD toured the kitchen. LPA observed the floors were replaced as part of the kitchen floor renovation project and the kitchen contains all necessary fixtures, tables, appliances, and equipment. LPA observed the kitchen to be clean and organized and observed no health and safety issues. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food. LPA observed lunch was being served with residents eating in the dining room. LPA confirmed the kitchen floor renovation project has been completed without issue. There were no health and safety concerns observed in the areas inspected. Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.the state’s words, verbatim · CDSS document, Sep 6, 2023

Type of visit: Case Management - Other

This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of following up on construction plans for renovating the kitchen floor submitted to the Orange County Regional Office (OCRO) on 06/27/23. LPA met with Administrator (AD) Maria Domingo and explained the purpose of the inspection. During the inspection, LPA and AD toured the facility, reviewed the facility’s construction plans, and discussed the plans. There is one kitchen at the facility and two bistros. All cooking is done in the kitchen while the bistros are used for serving. Prior to construction, the facility will have a mobile kitchen delivered to the back parking lot. The estimated date for the mobile kitchen being deployed is August. Once the mobile kitchen is deployed, the kitchen will be closed and the construction will take place. The construction will be focused on replacing the kitchen’s floor and replacing a few pieces of equipment. During construction, food will be cooked in the mobile kitchen and will enter the facility in large holding cabinets through the back door of the memory care unit. Food that is meant for the memory care will be served from the memory care bistro. Food that is meant for assisted living will be served from the assisted living bistro and will exit the memory care unit via the elevator. Staff delivering the food will ensure delayed egress alarms are re-armed at each door during transport. In addition, the memory care residents will be seated at the dining room and supervised by multiple staff during the food transport. The entire meal for each unit can fit on a single holding cabinet, so only one of the two cabinets will exit the memory care. This is similar to how a holding cabinet is currently used to bring food into the memory care. AD estimates the entire construction project will take less than two weeks after which point the mobile kitchen will be removed. During construction, the facility’s kitchen will be closed and locked and residents will not have access to it. Knives and cooking equipment will be locked in the mobile kitchen. The storage of cleaning supplies will not be affected by this project. Food will be stored in storage pods next to the mobile kitchen, which includes refrigerators and freezers. The construction crew will be managed by their manager and foreman. AD and the facility’s maintenance coordinator will meet with the manager and foreman weekly for updates. The protocol will be that the construction crew and their tools remain in the kitchen during construction and that the kitchen be locked to residents. There is a back door for the construction crew to enter and leave the kitchen without entering other parts of the facility or interacting with residents. During the inspection, LPA inspected the kitchen, bistros, parking lot, and travel pathways to be used during the construction. LPA advised AD to notify LPA once the construction has been completed. There were no health and safety concerns observed in the areas inspected. Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.the state’s words, verbatim · CDSS document, Jul 3, 2023

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Jessica Cho made an unannounced visit to conduct a case management for three incident reports received on 09/19/2022, 11/16/2022, and 12/03/2022. LPA met with Receptionist Christina Barton followed by Assisted Living Coordinator (ALC) Michelle Pineda who then notified Executive Director (ED) Tisset Domingo of LPA's arrival. Approximately 12:00pm, LPA met ED Domingo and stated the purpose of this visit. On today's visit, LPA conducted interviews with Resident 1(R1)- Resident 3 (R3) and staff. LPA obtained pertinent records for R1-R3. There were no immediate health and safety concerns. There were no deficiencies issued during this Case Management visit. An exit interview was conducted with Executive Director Tisset Domingo, and a copy of this report along with the LIC 811 were provided at the time of this visit.the state’s words, verbatim · CDSS document, Dec 8, 2022

Allegation investigated: -Facility is understaffed

On today’s date, Licensing Program Analyst (LPA) Rosie Quiroz conducted an unannounced visit to conclude this agency’s investigation into the complaint allegation mentioned above. LPA Rosie Quiroz arrived to the facility was COVID-19 screend and met with Business Office Director Lucy Yi. Director of Sales Patty Darsow joined the inspection tour on or about 10:18am. Executive Director Roxanne Psenicnik arrived on or about 10:47am. During the course of the investigation, LPA requested resident roster, staff schedules for October 2021-December 2021, Staff roster with contact phone numbers, Physician reports, Needs and Services Plans, and Identification Forms for Resident 1 (R1), Resident 2 (R2), Resident 3 (R3) and Resident 4( R4). During the initial visit LPA Quiroz also met with Thais Andrade Souza, Interim Executive Director (IED) and Ruby mendez, Assisted Living Coordinator who both confirmed that staffing has been a challenge due COVID-19 Pandemic, but denied that the resident’s needs were not being met. (IED) Thais Andrade Souza indicated that facility always have staff to cover the vacancies, so that there are always enough staff present to meet the needs of residents in care. CONTINUED ON NEXT PAGE... Substantiated CONTINUED... During the course of the investigation, LPA Rosie Quiroz interviewed Twelve interviewees. Twelve of Twelve interviewees indicated that facility is always experiencing staff shortages in “Reminiscence” Memory Care Unit. Twelve of Twelve interviewees indicated that when there’s a call off, staff have to work short which leads to resident’s needs not being met timely.” During today’s visit, on or about 9:52am, LPA Quiroz along with Lucy Yi, Business Office Director (BOD) toured The Reminiscence neighborhood Memory Care Unit. On or about 9:59am, while conducting inspection tour along with (bod) Yi, LPA Quiroz pulled chord in Room 316 at 9:59am. This was verified with (BOD) Lucy Yi. On or about 10:00am, while touring dining-room area with (BOD) Lucy Yi , LPA Quiroz observed 20 residents of which 16 of 20 residents were observed on the right side of dining-room unsupervised by staff and 4 of 20 residents on the left side of dining-room eating their breakfast supervised by Lead Care Manager. On or about 10:03am, LPA Quiroz observed vomit on Resident 2 (R2) and on floor area near (R2). On or about 10:04am, LPA Quiroz observed Resident 3 (R3) yelling "Want a drink." LPA Quiroz observed no staff supervising 16 of 20 residents sitting on right side area in dining room area. This was verified with (BOD) Lucy Yi. On or about 10:07am, LPA Quiroz inquired staffing ratio and numbers of staff present today. Lead Care Manager on duty verified that there were 2 Care Managers and 1 Lead Care Manager working today and indicated “1 agency staff called out today and no one showed up. Memory Care Director was informed.” During today’s visit, Medication Technician on duty was observed conducting medication technician duties. During today’s inspection tour visit it was reported by Lead Care Manager that 1 of 2 care Managers working on today’s date was out on break. During today’s visit, on or about 10:18am Director of Sales (D0S) Patty Darsow joined inspection tour. At this time Life Enrichment Manager was observed coming into the neighborhood to commence her assigned shift. LPA Quiroz along with Patty Darsow toured Room #13. On or about 10:19am, LPA Quiroz pulled call light chord in Room #13. LPA Quiroz and (DOS) Darsow waited until approximately 10:26am and no staff responded to call light. On or about 10:27am, LPA Quiroz and (DOS) Darsow walked back to dining-room area and inquired about call light services. Lead Care Manager pulled out her phone and said “Oh, Room #16 and Room #13 need help.” (DOS) Darsow asked Lead Care Manager and Agency Staff “How do you know residents need help or pulling chord?” Lead Care Manager then checked her phone and identified there were 2 call lights requiring assistance. The Lead Care Manager indicated that calls lights are identified via telephone and that Agency Staff did not have telephone access on today’s date. On or about 10:29am, LPA Quiroz observed Lead Care Manager give directive to Agency Staff to respond to call lights in Room #13 and Room #16 that were initiated at 9:59am and 10:19am. CONTINUED ON NEXT PAGE... CONTINUED... On or about 12:26pm, LPA Rosie Quiroz inquired about Agency Staff who had called out. (ED) Roxanne Psenicnik verified “I had another coordinator fill in until the Agency Staff arrived." COVID-19 check in screened verified, Staffing Agency arrived to facility on or about 11:33am. At 12:28pm, Executive Director Roxanne Psenicnik verified 22 of 24 residents in Reminiscence Memory Care Unit have a Dementia diagnose. Based on the information gathered through interviews, records reviewed, and observations conducted during today’s visit, the preponderance of evidence standard has been met therefore the above allegation is Substantiated. The following deficiency is being cited per Title 22, Div. 6 of the California Code of Regulations. (See Lic 809-D). This report, along with Appeal Rights and LIC 809-D were discussed with Executive Director Roxanne Psenicnik and provided via email.the state’s words, verbatim · CDSS document, Apr 5, 2022 · control 22-AS-20211026112550

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Apr 8, 2022

Personnel Requirements - General 87411(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 evidence by: On or about 10:00am, while touring dining-room area with (BOD) Yi CONT... LPA Quiroz observed 16 of 20 residents on the right side of dining-room unsupervised by staff.On or about 10:28am, LPA Quiroz and (DOS) Patty Darsow walked back to dining-room area and inquired about call light services. Lead Care Manager pulled out her phone and said “Oh, Room #16 and Room #13 need help.” CONTthe state’s words, verbatim · CDSS document, Apr 5, 2022

Plan of correction: (ED) Roxanne Psenicnik agreed to provide training on call light services response time to Facility and Agency Staff, and will provide CCLD with tool utilized and description of functionality in creating adequate staffing to meet resident's needs. ED will sibmit call off process follow up for NO SHOW staff by POC 4/8/2022 COB. On or about 10:29am, LPA Quiroz observed Lead Care Manager give directive to Agency Staff to respond to call lights in Room #13 and Room #16 that were initiated at 9:59am and 10:19am. This poses an immediate risk to residents in care.

Allegation investigated: -Residents sustained unexplained bruising while in care

On today’s date, Licensing Program Analyst (LPA) Rosie Quiroz conducted an unannounced visit to conclude this agency’s investigation into the complaint allegation mentioned above. LPA Rosie Quiroz arrived to the facility and was COVID-19 screened and met with Business Office Director Lucy Yi. Director of Sales Patty Darsow joined the inspection tour on or about 10:18am. Executive Director Roxanne Psenicnik arrived on or about 10:47am. During the pre investigation telephone call, Interviewee indicated requesting to remove allegation “Residents sustained unexplained bruising while in care.” Interviewee indicated not making that allegation. This agency has found the complaint allegation of " Residents sustained unexplained bruising while in care” is deemed UNFOUNDED; Meaning that the allegation was false, could not have happened or is without a reasonable basis. We have therefore dismissed the complaint allegation listed above. An exit interview was conducted with Executive Director Roxanne Psenicnik and a copy of this report was provided via email. Unfoundedthe state’s words, verbatim · CDSS document, Apr 5, 2022 · control 22-AS-20211026112550

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection (mitigation). LPA was screened for symptoms of Covid-19 and granted entry. LPA met with Resident Care Director (RCD) Roanna Cruz and Executive Director (ED) Roxanne Psenecnik . LPA explained the reason for the visit. LPA and the Executive Director toured the facility. Facility is one building with 3 levels. The bottom floor is the memory care unit. LPA tested the delayed egress exit door in the memory care patio. The delayed egress exit door functions properly, the alarm was triggered/sounded and the door opened after 15 seconds .LPA observed a small fountain in the patio. The fountain is surrounded by a small hedge and the fountain water level is under 2 inches deep. No obstacles or hazards observed in the patio. LPA observed the resident rooms in memory care had the required furnishings. The first and second levels are for assisted living. LPA observed the medication carts are kept locked so residents do not have access to the medication cart. LPA observed the kitchen had a 2 day perishable and 7 day non-perishable food supply on hand. The kitchen was clean and organized. LPA observed the emergency water and food supply is kept secured in a storage room. LPA observed the resident rooms on the first and second level (memory care unit is below the first level) had the required the furnishings. LPA observed an evacuation chair in the Southwest stairwell. LPA observed all fire extinguishers are fully charged. The last fire drill was conducted on 3/28/2022. The automatic fire sprinkler system was tested on 2/21/2022 with no deficiencies. No obstacles or hazards observed inside of the facility. Facility has submitted a mitigation plan that is pending approval. LPA consulted with the Executive Director concerning continued mitigation requirements and reporting requirements. No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided.the state’s words, verbatim · CDSS document, Apr 4, 2022