Sunrise Terrace RCFE III

Type of visit: Annual/Random

At 9:00am, on 9/1/2026, Licensing Program Analyst (LPA) Haner-Tomasko arrived at the facility unannounced to conduct the annual facility inspection. LPA met with backup administrator Edwin Ingan, announced who he was and the reason for the visit. Staff and LPA conducted a full tour of the facility. This facility is a single story residential home with four resident bedrooms (two are single occupancy and two are dual occupancy) and two full bathrooms (one is en-suite and one is for public/shared use). There is a living room, family room, a kitchen with dining space. Access to the laundry room and garage is through locked doors for resident safety. LPA noted that the backyard has seating and shade for residents and visitors. LPA noted fresh fruit and snacks in the kitchen for residents to enjoy freely. There is a wood brining stove in the living room that the Administrator states is not used. The facility has wired smoke detectors in each bedroom and hallway leading to bedrooms that are all working, the carbon monoxide detector is in the hallway and functioning normally. LPA observed a fire extinguisher near the kitchen that was tagged current and in the green compression range, serviced on 3/31/2026. LPA tested facility hot water at 114.6°F, within regulation temperatures 105-120°F. LPA observed at least 2-days of perishable and at least 7-days of nonperishable foods. LPA noted that the facility is clean and in good repair with no obstructions in hallways, doorways or exits. Medications are locked in a medication cart. LPA conducted a sample medication audit and reviewed the facilities Centrally Stored Medication Records. LPA conducted a staff and resident file review. LPA and Backup Administrator conducted a review of the annual care tool modules. There were no deficiencies cited at this time. Exit interview conducted, report signed, and report provided to the Backup Administrator.the state’s words, verbatim · CDSS document, Sep 1, 2026

Type of visit: Required - 1 Year

At 8:40am, on 8/26/2025, Licensing Program Analyst (LPA) Haner-Tomasko arrived at the facility unannounced to conduct the annual facility inspection. LPA met with backup administrator Edwin Ingan, announced who he was and the reason for the visit. Backup Administrator and LPA conducted a full tour of the facility. This facility is a single story residential home with four resident bedrooms (two are single occupancy and two are dual occupancy), two full bathrooms (one is on-suite and one is for public/shared use). There is a living room, family room, a kitchen with dining space. Access to the laundry room and garage is through a locked door for resident safety. LPA noted that the backyard has seating and shade for residents and visitors. LPA noted fresh fruit and snacks in the kitchen for residents to enjoy freely. The facility has battery operated and wired smoke detectors in each room and sprinkler system that were tested by Mid-Coast Fire Protection, Inc on 4/7/2025, the carbon monoxide detector is in the hallway and functioning normally. LPA observed a fire extinguisher near the kitchen that was tagged current and in the green compression range, serviced on 4/7/2025. LPA tested facility hot water at 113.1*(f), within regulation temperatures 105*-120* (f). LPA observed at least 2-days of perishable and at least 7-days of nonperishable foods. LPA noted that the facility is clean and in good repair with no obstructions in hallways, doorways or exits. Medications are locked in a medication cart. LPA conducted a sample medication audit and reviewed the facilities Centrally Stored Medication Records, finding no violations. LPA conducted a staff and resident file review. LPA and Backup Administrator conducted a review of the annual care tool modules. There were no deficiencies cited at this time. Exit interview conducted, report signed, and report provided to the Backup Administrator.the state’s words, verbatim · CDSS document, Aug 26, 2025

The state marks this report as 4 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

At 9:00 am on 09/30/2024, Licensing Program Analyst (LPA) Jeffries arrived unannounced at the facility to conduct the annual inspection for this facility. LPA met with Licensee Edwin Ingan, announced who he was and the reason for the visit. At 9:05pm Caregiver and LPA conducted a physical tour of the facility. LPA noted that this is a 3 bedroom, all rooms are double resident occupancy and two bathrooms, bathroom one is in a master bedroom and the other bathroom is in the hallway. Both bathrooms have secure handicap handrails, nonskid mats, properly functioning appliances, stocked, liquid soap and paper towels are also present in both bathrooms. All bedrooms are equipped to regulations, lights are working and beds have linins enough to meet regulation requirements. LPA noted that each bedroom has a wired smoke detector and smoke detectors in common areas of home, which are all hardwired. There is working carbon monoxide detector in the hallway. LPA noted that all exits are free and clear of obstructions. LPA observed the outside of the facility, with a table and umbrella for residents outside in the shade. LPA observed at least two days of perishable and seven days of non-perishable foods on hand. LPA noted that resident files, staff files and are locked in console cabinet below the TV in the living room and the medication cart is locked in the living room area. LPA conducted a medication audit inspection and found no regulation violations. LPA reviewed staff and resident files, LPA also reviewed staff training records and found no regulation violations. At 9:45am, Licensee and LPA conducted the review of each module of the care tools inspection tool. LPA noted that there were no violations of during the review of all of the care tool modules. At this time LPA found no violations of care tool module and physical inspection of the facility at this time. LPA conducted 3 staff and 3 resident interviews. Exit interview, report read, report singed, and report provided.the state’s words, verbatim · CDSS document, Sep 30, 2024

Allegation investigated: Staff did not refill resident’s medication prescription in a timely manner causing resident to get a seizure.

On 06/28/2024, at 11:50am, Licensing Program Analyst (LPA) Jeffries arrived to the facility unannounced to deliver the finial finding to the two allegations to this complaint. LPA met with Licensee, Edwin Ingan, announced who he is and the reason for the visit. As to the allegation of, “Staff did not refill resident’s medication prescription in a timely manner causing resident to get a seizure.” It was alleged that, facility failed to order Resident 1’s (R1) medication leading to a 4-day lapse in medication administration of specific medication and ultimately resulting in R1 having a seizure and hospitalization. It was discovered through documentation and interviews on 10/31/23 with Administrator Edwin Ingan, who stated that, medications in question were not in stock at primary pharmacy. Administrator stated that he was “working to fill the medication with the pharmacy”. Administrator also stated that R1 missed 4 days of medication in question and was hospitalized due to seizure. CONTINUED on LIC9099-C Substantiated Administrator stated that the medication in question of which R1 had missed for 4 days, was to address seizures. Administrator stated that he notified R1’s representative after R1 had the seizure and was hospitalization occurred on 10/27/2023. LPA Jeffries collected and reviewed Serious Incident Report dated 10/27/23 from facility reporting R1 seizure, UTI, hospitalization, and note indication “BE SURE MEDICATIONS ARE FILLED IN TIMELY MANNER. NOTIFY POA, DOCTOR, ADMINISTRATOR …” LPA reviewed Facility Centrally Stored Medication Records (CSMR) for R1 and noted that the medication in question was filled on 10/27/2023 after R1 had gone to the hospital due to seizure. Based on documentation, interviews, medical records and admission, there is enough evidence to support the allegation of, “Staff did not refill resident’s medication prescription in a timely manner causing resident to get a seizure.” and is substantiated at this time. Administrator was informed that the case will be reviewed and it is possible additional civil penalties could assessed based on Health and Safety Code 1569.49(f). Exit interview, report read, citation and fine issued, appeal rights and report provided.the state’s words, verbatim · CDSS document, Jun 28, 2024 · control 29-AS-20231030143848

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(1) · Plan of correction due date: Jul 1, 2024

87465 Incidental Medical and Dental Care (a) A plan for incidental medical ... shall be developed by each facility. The plan shall encourage routine medical ... provide for assistance in obtaining such care, by compliance with the following:(1) The licensee shall arrange, or assist in arranging, for medical... appropriate to the conditions and needs of residents. This requirement was not met by evidence of admission of medication error resulting in R1 seizure and hospitalization, which put the resident in iminate dangerthe state’s words, verbatim · CDSS document, Jun 28, 2024

Plan of correction: Licensee agrees to a comprehensive 2-4 hour training corse of their choice on medications for all staff associated to this facility. Plan for completion and schedule should be emailed to LPA no later than 07/01/2024 by end of busniess day. (mark.jeffries@dss.ca.gov)