Sunrise Homes

Type of visit: Required - 1 Year

On 5/26/23 at approximately 9:30am Licensing Program Analyst (LPA) Maja Jensen arrived unannounced to conduct a required 1 year annual inspection. LPA Jensen met with Licensee Elizabeth Abesa and explained the purpose of today's visit. Elizabeth holds current Administrator certificate # 6010093740 good through 10/26/23. LPA Jensen toured the grounds and interior of the facility. The grounds were observed to be maintained and all paths were clear of obstruction. Window screens were determined to be in good repair. There is outdoor furniture and shaded areas available for outdoor activities. LPA Jensen observed the interior of the facility to be sanitary and free of odor. The facility maintains adequate furnishings and lighting. Each bedroom was observed to have a dresser, night stand, lamp and chair. The thermostat was set at 68 degrees for the residents. The water temperature was measured at 110.9 degrees and is within the required range of 105-120 degrees. The bathrooms are equipped with grab bars at the toilet and in the shower. The bathrooms are equipped with paper towel dispensers for single use. The waste containers were observed to have tight fitting lids. The facility kitchen was inspected. The facility maintains 2 day supply of perishable food and 7 day supply of non-perishable food. Lunch preparation and service was observed. The lunch menu consisted of fish, scalloped potatoes, salad and juice. LPA Jensen observed fresh fruit and vegetables on hand. An adequate supply of linen is kept on site. Bedding was observed to be clean. Medication was locked and inaccessible to residents in care. PRN medication is documented appropriately for effectiveness. Medication was observed to be pre-poured for the next two days. LPA Jensen conducted a count of 1 resident's medication and determined the count to be accurate. The facility maintains a first aid kit that was determined to be complete with scissors, tweezers, thermometer, manual and various wound dressings. The fire alarm and carbon monoxide detector were tested and determined to be in good working order. The facility maintains emergency lighting and supplies. The fire extinguisher was last serviced in February of 2023 and is in compliance. Continued on LIC 809C.... The Emergency Disaster Plan was reviewed and current. LPA Jensen observed signage for Resident Council, Personal Rights, Ombudsman, See Something, Say Something and infection Control. LPA Jensen interviewed 1 staff member and 1 resident. LPA Jensen reviewed 3 of 10 resident files. 3 of 3 resident files contained outdated Needs and Service Plans. LPA Jensen reviewed 2 of 4 staff files. The staff files were determined to be in compliance. LPA Jensen requested an updated copy the LIC 500. Deficiencies are being cited from the California Code of Regulations (CCR) Title 22. Failure to correct deficiencies may result in the assessment of Civil Penalties. An exit interview was conducted and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, May 26, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(h)(5) · Plan of correction due date: Jun 2, 2023

Incidental Medical and Dental Care The following requirements shall apply to medications which are centrally stored: ... Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement was not met as evidenced by: Based on LPA Jensen's observation of medication that was pre-poured for administration in to separate containers. This poses a potential risk to the residents health, safety and personal rightsthe state’s words, verbatim · CDSS document, May 26, 2023

Plan of correction: The Licensee agrees to immediately cease pre-pouring medication and to conduct in-service training by 6/2/23 with proof of completion of training to be sent to maja.jensen@dss.ca.gov by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87463(c) · Plan of correction due date: Jun 23, 2023

Reappraisals The licensee shall arrange a meeting with the resident, the resident’s representative, if any, appropriate facility staff, and a representative of the resident’s home health agency, if any, when there is significant change in the resident’s condition, or once every 12 months. This requirement was not met as evidenced by: Based on LPA Jensen's review of resident files, 3 of 3 Needs and Service Plans were not updated within the last 12 months. This poses a potential risk to the health Safety and Personal Rights of residents ion carethe state’s words, verbatim · CDSS document, May 26, 2023

Plan of correction: The Licensee agrees to update the Needs and Service Plans by POC due date and email an attestation that this has been completed to maja.jensen@dss.ca.gov.

Type of visit: Case Management - Health Checks

On 12/9/22 at 10:40am, Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to conduct a quarterly visit/health and safety check. LPA Jensen met with Licensee Elizabeth Abesa and explained the purpose of today's visit. The facility does not handle P&I funds. The facility does however assist with check cashing. The facility maintains a check cashing register for all residents. The register lists the check date, the check number, a description of what the check was issued for, the check amount, the date disbursed and resident signature. LPA Jensen reviewed the check register for resident 1 through resident 4 and determined that the entries reflected an accurate accounting. LPA Jensen toured the facility including grounds and facility interior. The facility was observed to be sanitary and free of odor. The water temperature was measured at 108 degrees which falls within the regulatory requirement of 105-120 degrees. The thermostat was set at 72 degrees for the comfort of the residents. LPA Jensen observed in excess of a 2 day supply of perishable food and a 7 day supply of non-perishable food. There are 8 resident bedrooms of which 7 are double occupancy and one is single occupancy. Resident bedrooms were observed to be furnished with dresser, night stand, lamp and chair for each resident. All paths on the grounds were observed to be free of obstruction and the grounds were observed to be free of debris. No deficiencies were cited as a result of this visit. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Dec 9, 2022

Type of visit: Case Management - Incident

On 12/9/22 Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to conduct a case management for an incident report and LIC 624 and LIC 624A. LPA Jensen met with Licensee Elizabeth Abesa and explained the purpose of today's visit. LPA Jensen interviewed licensee for a timeline of events. On the date in question, Resident 1 (R1) was acting normally. On this date her case manager had called between 2pm and 3pm and staff advised that R1 was doing fine. On this date R1 had been observed engaging with other residents and at dinner at approximately 4pm with no unusual activity or behavior observed. The facility charts any unusual activity such as decreased appetite etc... On the date in question there was an entry related to incontinence however this was not an unusual occurrence. Medication pass is typically done around 6pm. Between 5:45 and 5:55pm, the medication technician found R1 found to be unresponsive in bed. The medication technician attempted to arouse the patient unsuccessfully, called the Licensee who had just left the facility and was one block away. 911 was called at 5:57 by the medication technician. The ambulance responded within 5-10 minutes. The Licensee contacted the R1's family at 6:14pm. R1 was transported to the hospital by ambulance. The facility telephone logs times and dates of calls. Call times were verified by the telephone call history. Based on interviews conducted, file review and phone records the facility was determined to have fulfilled their required duties in a timely manner. No deficiencies are being cited as a result of this visit.the state’s words, verbatim · CDSS document, Dec 9, 2022

Type of visit: Case Management - Health Checks

On 9/16/22 at 10:00am Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to conduct a quarterly health and safety check. LPA Jensen met with Administrator Elizabeth Abesa and explained the purpose of today's visit. Upon arrival LPA Jensen was screened for COVID-19 and signed in at the front entrance. LPA Jensen observed the ambient temperature in the facility to be 72 degrees which falls within the regulatory range of 68-85 degrees. LPA Jensen measured the water temperature in 1 bathroom at 129.7 degrees, there was a caution hot water sign posted above the faucet. LPA Jensen observed a 2 day supply of perishable food and a 7 day supply of non-perishable food on site. No expired food was observed at the facility. LPA Jensen observed lunch service which consisted of broccoli, rice, macaroni and cheese and fish sticks with the option of chicken nuggets for anyone that doesn't eat fish. At 11:30am LPA Jensen observed traps in the kitchen for rodents and rodent droppings on the floor of the facility kitchen in 2 places, on each side of the dividing wall that separates the kitchen and the dining room. LPA Jensen interviewed Administrator Elizabeth Abesa who advised that they have a contract with a pest control company Terminix who is on schedule to come out bi-monthly. The Administrator confirmed that because the facility is located in a rural agricultural area there are rodents and the pest control company is working with the facility to eradicate the problem. LPA Jensen reviewed two staff files for staff 1 (S1) and staff 2 (S2). S1 had verification of completion for on-line training for CPR that was completed in 2021 but a certification of completion that includes hands on practice and evaluation was not present in the file. The resident file for S2 did not contain a CPR certificate or any evidence of CPR training. LPA Jensen interviewed the Administrator regarding the CPR certifications. Continued on LIC 809c.... Continued from LIC 809.... The Administrator confirmed that S2 is not CPR certified and stated that S1 had completed the certification process in 2021 but the certification was not received for placement in the file or available during the course of the visit. Deficiencies are being cited from the California Code of Regulations, Title 22, Division 6. An exit interview was conducted and a copy of this report along with appeal rights was given to the facility Administrator Elizabeth Abesa.the state’s words, verbatim · CDSS document, Sep 16, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Oct 1, 2022

(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met as evidenced by: Based on LPA's observation of rodent droppings in two places in the kitchen area adjacent to the dining room. This poses a potential health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 16, 2022

Plan of correction: Licensee agrees to conduct a deep clean of the combined kitchen/dining room area. Licensee will email photos or video as proof of correction to maja.jensen@dss.ca.gov by due date

From the deficiency page — Deficiency type: Type B · Section cited: CCR87411(c)(1) · Plan of correction due date: Oct 14, 2022

(c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 (1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement was not met as evidenced by: Based on LPA Jensen observation that 2 of 2 staff present during the facility visit did not have current 1st aid certifications present in their staff files. This poses a potential health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 16, 2022

Plan of correction: Licensee agrees have to have all staff that provides care to residents 1st aid certified by the Plan of Correction due date. Licensee will email proof of CPR certification for S1 and S2 to maja.jensen@dss.ca.gov by due date.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) T. White made an unannounced visit on this day for the purpose of conducting a Case Management, Health and Safety visit. LPA met with Administrator, Elizabeth Abesa and explained the purpose of the visit. Present at time of visit were 12 residents and 3 staff members. LPA inspected the interior and exterior of the facility. LPA verified that the facility had running water and electricity. LPA tested water temperature in the resident's bathrooms which measured 119.1 degrees F. LPA inspected food supplies and observed two days worth of perishable and seven days worth of non-perishable foods. LPA did not observe any concerns. An exit interview was conducted with Administrator and a copy of this report provided.the state’s words, verbatim · CDSS document, May 25, 2022

Type of visit: Required - 1 Year

On 05/25/2022 at 9:15 am, Licensing Program Analyst (LPA) T. White arrived unannounced to conduct a required 1-year annual inspection. LPA met with Caregiver, Amy Dolores and explained the purpose of today’s inspection. LPA was allowed entry into the facility that is licensed to serve a total capacity of 15 residents. LPA later met with Administrator, Elizabeth Abesa who holds a certificate #6010093740 that expires on 10/26/2023. LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. All outdoor and indoor passageways are kept free of obstruction. A comfortable temperature is maintained at 75 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 119.1 degrees Fahrenheit. There is a minimum of 7-day supply of nonperishable and 2-day of perishable foods. Smoke detectors and carbon monoxide were in operating condition during inspection. Fire extinguisher was last serviced on February 09, 2022. First aid kit was observed to be complete. LPA observed completed mitigation plan. LPA reviewed 5 resident files and 3 staff record files. LPA observed the following deficiency: - LPA observed Staff #3 (S3) does not have a Health Screening or TB test on file. The following deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiency may result in civil penalties. Exit interview conducted with Administrator. A copy of report and Appeal Rights given.the state’s words, verbatim · CDSS document, May 25, 2022

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) T. White made an unannounced visit on this day for the purpose of conducting a Case Management, Health and Safety visit. LPA met with Administrator, Elizabeth Abesa and explained the purpose of the visit. Present at time of visit were 9 residents and 2 staff members. LPA inspected the interior and exterior of the facility. LPA verified that the facility had running water and electricity. LPA tested water temperature in the resident's bathrooms which measured 114.8 degrees F. LPA inspected food supplies and observed two days worth of perishable and seven days worth of non-perishable foods. LPA did not observe any concerns. An exit interview was conducted with Administrator and a copy of this report provided.the state’s words, verbatim · CDSS document, Feb 22, 2022

Allegation investigated: Facility is cashing resident's checks after declining resident to return to facility.

On 11/5/2021 at 3:45pm Licensing Program Analyst (LPA) Ashley Boothe arrived to deliver an amendment of complaint investigation findings with the following allegations: Facility is cashing resident's checks after declining resident to return to facility. LPA met with Administrator and stated the purpose of the visit. Today's Census 10. The complaint findings have changes and this 9099 supercedes complaint findings LPA delivered to Administrtor on 8/17/2021. During the course of the investigation the Department reviewed records, conducted interviews and on site inspection. In March, Resident one (R1) experienced a medical emergency and was transported to hospital. Administrator informed ER R1 required an increased level of care which the facility could not provide. Upon discharge R1 was admitted to a skilled nursing facility (SNF) for rehabilitation. Upon admission SNF notes Administrator stated that R1 needed a long-term care facility and the facility was not able to care fore R1’s needs. Administrator expressed that if R1 improved Administrator would return to reassess R1 for return to facility. Substantiated Administrator did not reappraise R1 and R1 did not return to the facility. Administrator did not notify R1’s payee of R1’s transfer to hospital or SNF. Administrator continued to collect and cash R1’s rent and personal spending checks from R1’s payee through June 2021 while R1 was not residing in the facility and no services or care were provided to R1 without documenting a reappraisal to determine if R1’s level of care need could be met by the facility. Based on information obtained the aforementioned allegation is SUBSTANTIATED. A finding that the complaint is substantiated means the preponderance of evidence standard has been met, therefore the allegation is found to be substantiated. Per California Code of Regulations (CCRs) - Title 22, Division 8, the following deficiencies are being cited on the attached 9099D during this visit. A copy of their rights (LIC9058) provided and a signature on this form acknowledges receipt of these rights. Exit interview held and a copy of report provided.the state’s words, verbatim · CDSS document, Nov 5, 2021 · control 27-AS-20210720113955

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87463(b) · Plan of correction due date: Nov 19, 2021

Reappraisals (b) The licensee shall immediately bring any such changes to the attention of the resident's physician and his family or responsible person. This requirement is not met as evidence by: Based on observation, interview and record review the Licensee did not comply with the section cited above in that administrator did not reappraise in writing R1 at hospital or SNF to determine R1 care level needs and notify R1's payee of change in condition which poses an potential health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Nov 5, 2021

Plan of correction: The Licensee agrees to submit a written declaration to maintain compliance with this regulation at all times to LPA by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87217(a) · Plan of correction due date: Nov 19, 2021

Safeguards for Resident Cash, Personal Property, and Valuables (a) … a resident incapable of handling his own cash resources, as documented by the initial or subsequent appraisal, … cash resource shall be safeguarded in accordance with the regulations in this section. This requirement is not met as evidence by: Based on observation, interview and record review the Licensee did not comply with the section cited above in that the Licensee did not safeguard R1’s monies by cashing checks without reappraising R1 and did not notify R1’s payee of R1’s no longer in the facility which poses a potential health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Nov 5, 2021

Plan of correction: The Licensee agrees to submit a written declaration to maintain compliance with this regulation at all times to LPA by POC due date.

Allegation investigated: Financial Malfeasance

On 11/5/2021 at 3:45pm Licensing Program Analyst (LPA) Ashley Boothe arrived to deliver complaint investigation findings with the following allegations: Financial Malfeasance. LPA met with Administrator and stated the purpose of the visit and was allowed entry to the facility. Today's Census 10. During the course of the investigation the Department reviewed records, conducted interviews and on site inspection. Administrator engaged in two instances of financial malfeasance for accepting rent and personal and incidental payments knowing R1 was not in care and would not be returning. Administrator was notified by Social Security Administration that rents could not be kept after 30 days when a resident is admitted to hospital or other care. The first instance from November 2018 through April 2019 in total of $6070 for rent and personal monies. The second instance from mid March 2021 through June 2021 in total of $4725 for rent. Administrator admitted the facility could not provide the level of care needed, however did not report to R1’s payee and continued to receive funds until contacted. Substantiated Continued from 9099. Facility Admissions Agreement states rate shall be $1350 per month. Section 18, termination of contract, states the agreement will be terminated upon the determination of the resident’s needs and transitions into a higher level of care. Section 9, refund policy, would not apply as administrator repeatedly informed Hospital and SNF she would not be able to provide the level of care needed for R1. Based on information obtained the aforementioned allegation is SUBSTANTIATED. A finding that the complaint is substantiated means the preponderance of evidence standard has been met, therefore the allegation is found to be substantiated. Per California Code of Regulations (CCRs) - Title 22, Division 8, the following deficiencies are being cited on the attached 9099D during this visit. A copy of their rights (LIC9058) provided and a signature on this form acknowledges receipt of these rights. Exit interview held and a copy of report provided.the state’s words, verbatim · CDSS document, Nov 5, 2021 · control 27-AS-20210827101759

From the deficiency page — Deficiency type: Type B · Section cited: CCR 1569.58(a)(5) · Plan of correction due date: Nov 19, 2021

(a) The department may deny an application for a license or may suspend or revoke a license issued under this chapter upon any of the following grounds and in the manner provided in this chapter: (5) Engaging in acts of financial malfeasance concerning the operation of a facility, including, but not limited to, improper use or embezzlement of client moneys and property or fraudulent appropriation for personal gain of facility moneys and property, or willful or negligent failure to provide services for the care of clients. This requirement is not met as evidence by: Based on observation, interview and record review the Licensee did not comply with the section cited above in that the Administrator engaged in financial malfeasance by securing R1’s rent and personal monies while R1 was not in care which poses a potential health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Nov 5, 2021

Plan of correction: The Licensee agrees to submit a written declaration to pay R1’s payee to LPA by POC due date. All payments made in total of $10795 shall be paid R1’s payee no later than 6 months from today’s date.

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Ashley Boothe arrived unannounced on 10/27/2021 at 8 am to conduct an unannounced case management visit following an incident report submitted to the department. LPA met with Administrator and stated the purpose of the visit. Current census is 10. During the visit LPA conducted interviews and reviewed records. LPA reviewed record of one incident where Resident one (R1) was observed to show behaviors off baseline of attempting to burn clothes. R1's responsible party and physician was notified. R1 admitted to hospital for evaluation and symptoms resolved after medication administered per physician's orders. R1 observed regularly was revaluated after incident and will follow increased appointments. Administrator stated the facility will continue to provide increased monitoring and coordination for psychiatric appointments to observe R1 for changes in conditions. LPA observed physician's report last updated in 12/2015. LPA provided technical assistance to update physician's assessment and document updated care plan to ensure R1's increased monitoring is documented and available for records review. LPA conducted a case management inspection to ensure proactive measures were put in place to prevent further incidents. If there is another reoccurrence of the same nature the department will require resident be reassessed by their physician to determine if the current placement continues to be appropriate. Per the California Code of Regulations, Title 22, no deficiencies observed or cited. Exit interview held, copy of report given.the state’s words, verbatim · CDSS document, Oct 27, 2021

Type of visit: POC

On 8/31/2021 at 9:45am, Licensing Program Analyst (LPA) Ashley Boothe arrived unannounced to conduct a POC visit. LPA met with Administrator and explained the purpose of today’s visit. Prior to today's visit LPA contacted Administrator regarding facility risk assessment questions. Administrator confirmed no staff or residents have experienced symptoms within the last 10 days. LPA was allowed entry into the facility, current census is 10. Deficiency cited under Title 22 87303(c) during inspection on 6/03/2021 included missing window screens in resident rooms, common area, and kitchen. Licensee complied with the terms of the POC by approved extension of POC due date. POC letter provided during today's inspection. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Aug 31, 2021

Allegation investigated: Facility is cashing resident's checks after declining resident to return to facility.

On 11/5/2021 at 3:45pm Licensing Program Analyst (LPA) Ashley Boothe arrived to deliver an amendment of complaint investigation findings with the following allegations: Facility is cashing resident's checks after declining resident to return to facility. LPA met with Elizabeth Abesa and stated the purpose of the visit. Today's Census 10. This is an amendment of 9099 report delivered to Elizabeth Abesa by LPA Ashley Boothe on 8/17/2021. A new 9099 was created as the findings were changed. The new 9099 supersedes the previous report. Page 1 of 2. Unsubstantiated This is an amendment of 9099 report delivered to Elizabeth Abesa by LPA Ashley Boothe on 8/17/2021. A new 9099 was created as the findings were changed. The new 9099 supersedes the previous report. Page 2 of 2.the state’s words, verbatim · CDSS document, Aug 17, 2021 · control 27-AS-20210720113955