Sunrise of San Mateo

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to conduct a Required - 1 Year visit on 9/24/23 at 9:00AM. LPA met with Abbie Apolinario, Administrator, Leslie Guerrero, Reminiscence Coordinator, StelaMarie Pham, Resident Care Director, Joanne-Ruth Gutierrez, Assisted Living Coordinator, Robert Graves, Maintenance Coordinator and stated the purpose of todays visit. The facility is licensed for a capacity of 85 non-ambulatory residents. Hospice approved for 20. Maximum 27 residents in Memory Care Unit rooms 400-416. The Administrator Certificate was observed for Abbie Apolinario expires 10/18/2024. There are 6 residents receiving hospice care services. There are 0 bedridden residents at this time. Facility has a delayed egress system. LPA toured and inspected the physical plant inside and outside to ensure there are no safety hazards to residents. LPA observed and conversed with residents during this visit. LPA observed 2-day perishables and 7-day non-perishables. The temperature inside the facility was observed to be between 71-74*F which is within the required range of 68-85*F. The hot water temperature was measured between 112.3-114.6*F which is within the required range of 105-120*F. LPA observed fire extinguisher(s), smoke and carbon monoxide detectors, pull alarm system and central heating and air in the facility. LPA observed the centrally stored medications area to be locked and inaccessible to residents. The first aid kit contained the required items such as sterile dressings, bandages, adhesive tape, scissors, tweezers, thermometers, antiseptic solution and guide. LPA observed 3 staff and 3 resident files and conducted interviews during this visit. Upon a file review the following items were discussed to be submitted with any changes annually: Any addendums to Infection Control Plan, Designation of Facility Responsibility (LIC308), Liability Insurance Personnel Report (LIC500), Administrator Certificate-Updated, LIC400, LIC402, Control of Property, Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies observed or cited. Exit interview held, copy of report giventhe state’s words, verbatim · CDSS document, Sep 24, 2023

Allegation investigated: Resident sustained injuries while in care

On December 27, 2021, Licensing Program Analyst (LPA) Komal Charitra met with Dining Service Coordinator, Josephine Chan to deliver the findings for the above allegation. Regarding the allegation that resident sustained injuries while in care. On October 17, 2021, Resident (R1) sustained a fall. According to the complainant, R1 was found on the floor covered with blood with bruises and skin tears. According to Administrator, R1 is independent and can perform his daily activities without staff supervision. Based on the interviews conducted during the investigation, R1 was admitted about 5 years ago as “independent living.” Because R1 was admitted as independent living, he/she did not require staff to check on R1 as often as assisted living residents. R1 was able to voice concerns on his own. (CONTINUE TO 9099C) Unsubstantiated Although, R1 sustained new injuries from this incident, facility records document that the resident was independent and did not require multiple checks, resident was alert and able to verbalize needs. Therefore, based on the information collected, and interviews, the allegation that the resident sustained injuries while in care is UNSUBSTANTIATED, meaning that although the allegation may have happened or is valid, there is no preponderance of evidence to prove that the alleged violation occurred Report is reviewed with Josephine Chan and a copy is provided.the state’s words, verbatim · CDSS document, Dec 27, 2021 · control 14-AS-20211018083952

Allegation investigated: Staff not assisting resident with incontinence care Resident’s mattress was soaked in urine Facility was not clean

On November 23, 2021, Licensing Program Analyst (LPA) Komal Charitra met with Resident Care Diector, Deanna Chan to deliver the findings for the above allegations. On 10/18/2021 the Department received a complaint alleging that during an emergency response to the facility on 10/17/2021, a resident (R1) was found in distress; the mattress was soaking in urine and the room was unclean. Therefore, all these allegations refer to that particular incident and room. The presence of a mattress soaked in urine is a fact related to the allegation of the facility not being clean. Substantiated During the investigation, LPA Charitra interviewed staff, reviewed R1’s documentation and file, and inspected the bedroom. Interviewed staff indicated that R1 was admitted back in January of 2016 as an “independent” resident. The file review revealed that the continence products will not be used, although according to staff, R1 required briefs and pull-ups. The interviews also revealed that R1 had a history of urinating in his/her clothes. This resulted in an increase in the frequency of checks and elevating R1’s condition to a Level 2, requiring the use of additional changes of underwear and the use of pull-ups. Nevertheless, the licensee failed to update the physician report and/or to reappraise in order to develop an appropriate care plan to address R1’s health changes. The department received several reports that on the day of the incident, the room where R1 was found was disheveled and there was a strong smell to urine. R1’s room was inspected by LPA Charitra on October 27, 2021, 10-days after the incident. The windows were closed, the room was in disheveled and there was a strong smell to urine. According to the Administrator, the windows were closed due to a storm that took place on October 24th, a week and after the incident occurred. The mattress had been removed and yet the urine smell was strong. On November 10, 2021, almost three weeks after the incident, LPA Charitra and Investigator Phung conducted another unannounced visit to the facility and observed the resident’s room. The bed frame had been removed, and windows were observed to be open. The urine smell is still in the room. The facility incident report only acknowledges that the resident had an accident on 10/17/2021; however, the information collected provides preponderance of evidence to indicate that R1’s had been experiencing incontinency for some time. Based on the above information and documentation, it was determined that the licensee failed to document R1’s health changes and consequently failed to meet R1’s needs and failed to provide appropriate care and assistance. Furthermore, the licensee failed to assist resident with incontinence care and failed to maintain the resident’s room in sanitary condition. The preponderance of evidence standard has been met; therefore, these allegations are Substantiated. The following deficiency was cited per CA Code of Regulations Title 22-refer to the 9099D and appeal rights were provided. Therefore, based on the information collected, and interviews, the allegation that the licensee failed to address the resident’s diabetes is UNSUBSTANTIATED, meaning that although the allegation may have happened or is valid, there is no preponderance of evidence to prove that the alleged violation occurred.the state’s words, verbatim · CDSS document, Nov 23, 2021 · control 14-AS-20211018083952

From the deficiency page — Deficiency type: Type A · Section cited: HSC 87466 · Plan of correction due date: Nov 29, 2021

87466 Observation of Resident, The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. When changes such as unusual weight gains or losses or deterioration of mental ability or a physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. Violation of this regulation is evidence by staff interviews indicating awareness that R1 had experienced health changes, among them a history of urinating in his/her clothes. This awareness is also shown by a single document indicating that the level of care had changed to a Level 2, requiring the use of additional changes of underwear and the use of pull-ups. Nevertheless, the licensee failed to update the physician report, failed to reappraise and failed to develop an appropriate needs and services plan to address R1’s health changes.the state’s words, verbatim · CDSS document, Nov 23, 2021

Plan of correction: Facility shall develop a written plan of correction (POC) describing how facility shall ensure compliance with 87466. Staff shall conduct additional training if needed. POC shall include measures to be implemented to prevent a repeated occurrence and submitted to CCLD before due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a)(1) · Plan of correction due date: Nov 29, 2021

87303(a)(1) Maintence and Operation, 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.Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition Violation of this regulation is evidence by several eyewitness who have indicated that the room was in dishevel, the mattress was soaked in urine, and the room was unsanitary. These reports were confirmed by the LPA observations on 10/27/2021, when the room was in dishevel, and had a strong urine smell, and 11/10/2021, when the room was still retaining a strong odor to urine even after the windows had been opened and facility had a chance to clean.the state’s words, verbatim · CDSS document, Nov 23, 2021

Plan of correction: Facility shall develop a written plan of correction (POC) describing how facility shall ensure compliance with 87303(a)(1). POC shall include measures to be implemented to prevent a repeated occurrence and submitted to CCLD before due date.

The state marks this report as 6 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.