Sunrise Assisted Living of Carmichael

Allegation investigated: Staff do not ensure the facility is clean and sanitary. Facility is malodorous. Staff do not ensure the facility is properly maintained

On 8/5/26, Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced to deliver complaint findings into the allegations listed above and met with Administrator Jessica Sanders. During the investigation, the Department conducted interviews and reviewed documentation pertinent to the investigation. The results of the investigation are as follows: **Report continued on 9099-C** Unfounded **Report continued from 9099..... Allegation- Staff do not ensure the facility is clean and sanitary .UNFOUNDED During the investigation, interviews were conducted with four staff members and three residents. Staff consistently reported that the facility is cleaned daily and that housekeeping services are performed on a routine basis. Staff further stated that housekeeping and maintenance personnel are contacted as needed to address any additional cleaning concerns. Residents interviewed reported no concerns regarding the cleanliness or sanitation of the facility. The Department did not obtain evidence to support that staff failed to ensure the facility was maintained in a clean and sanitary condition. Therefore, the allegation is determined to be unfounded. A finding of unfounded means that the allegation is false, could not have happened and/or is without a reasonable basis. Allegation- Facility is malodorous .UNFOUNDED Interviews with four staff members and three residents revealed no reports or observations of persistent unpleasant odors within the facility. Residents stated they had not experienced or noticed malodorous conditions. The Department did not obtain evidence demonstrating the presence of odors that would indicate the facility was not maintained in accordance with applicable health and sanitation requirements. Therefore, the allegation is determined to be unfounded. A finding of unfounded means that the allegation is false, could not have happened and/or is without a reasonable basis. Allegation- Staff do not ensure the facility is properly maintained. UNFOUNDED Interviews with four staff members established that maintenance requests are submitted as needed and addressed promptly by maintenance personnel. Staff reported that repairs are completed in a timely manner when issues arise. Residents interviewed did not express concerns regarding the maintenance or condition of the facility. The Department did not obtain evidence that the facility was not properly maintained or that staff failed to ensure necessary maintenance was performed. Therefore, the allegation is determined to be unfounded. A finding of unfounded means that the allegation is false, could not have happened and/or is without a reasonable basis. Exit interview conducted. Report left with facility.the state’s words, verbatim · CDSS document, Aug 5, 2026 · control 59-AS-20260703150941

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Lavinia Muscan arrived on 05/27/2026 to conduct the annual inspection. During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPA reviewed five resident (5) and five staff files (5). All resident files contained the required paperwork. All staff files contained the required paperwork. Facility was clean and well organized. Facility is current on fire drills. All required posting were observed. Staff training contained the required initial training. LPA and Administrator toured the facility together to ensure the health and safety of residents in care. The areas toured included resident rooms, bathrooms, kitchen, dining room, hallways, and common areas. The food supply is within compliance, 2 days of perishable and 7 days worth of non-perishable food items. Grab bars were present at the toilet and in the shower. All exits were unobstructed. The disaster drill is current. The administrator's certificate is current. LPA checked the kitchen area for the ability to prepare and store food. LPA observed cleaning products and other toxins to be locked away. LPA observed the area used for medication to be locked and inaccessible to residents. LPA observed smoke detectors and carbon monoxide detector are operational. Fire extinguisher is ready for emergency use. Water temperature is within compliance. In the areas toured, there were no health or safety violations observed. LPA requested a copy of the LIC500, LIC610E and current liability insurance to be sent to the Department by end of the month. Exit interview conducted. A copy of this report was printed and given to facility.the state’s words, verbatim · CDSS document, May 27, 2026

Allegation investigated: -Staff administered medication to resident in care without obtaining a physician's prescription order -Staff did not complete required training

Licensing Program Analyst (LPA) Angela Hood arrived at the care home today and met with the Business Office Coordinator, Hazel Gober, to deliver complaint investigation findings regarding the above stated allegations. During the course of the investigation, LPA conducted interviews and obtained documentation pertinent to the investigation. According to the facility’s Resident Handbill, resident (R1) moved into the care home on May 31, 2025. After Visit Summary and Physician Progress Notes, dated May 25, 2025, indicated that R1 was to begin taking Cefadroxil 500mg capsules for 7 days due to urinary tract infection (UTI). Interview with Executive Director (ED) Jessica Sanders, staff (S1), and witness indicated that R1 had 2 more days of medication to take upon ***********************************************Continued on LIC9099-C************************************************** Substantiated move in. LPA reviewed R1’s Centrally Stored Medication and Destruction Records, Medication Order Summary Report, and the Medication Administration Record (MAR) which did not indicate the facility had a medication order for Cefadroxil 500mg capsules and there was no entry for the medication. Interview with ED indicated that they do not typically pass medications, however, they did one time when R1 moved into the care home. Interviews with S1, staff (S3), and witness indicated that ED provided R1 with their Cefadroxil 500mg capsules. Interviews with S1, S3, and staff (S4) indicated that typically the nurses and med techs pass medications. Interviews with S1, S2, and witness indicated that there were no medication orders for R1’s Cefadroxil 500mg capsules. According to facility’s Plan of Operation, “a resident may self-administer his or her own medications only when there is proper documentation from the physician”. The Plan of Operation also indicated that the facility is to “maintain a current residents with self-medication orders form in the Wellness Center”. To date, the facility was unable to provide LPA with a medication order for R1’s Cefadroxil 500mg capsules. Interview with ED indicated that they have taken medication training as they are the ED of the care home. Interviews with S2, S4, and witness indicated that the facility has a policy to complete medication training if staff are going to be passing medications to residents in care. Interviews with S4, witness, and Business Office Coordinator indicated that the facility has required Medication Management training that staff are to complete if they will be passing medications. Upon review of ED’s training documentation that was provided, the ED does not have current medication management training. According to the facility’s Plan of Operation, “team members administering medications must fall under one (1) of the following areas: A licensed health care professional, has successfully completed a state approved medication training course, has completed a Sunrise medication training program, if a state approved medication training course is not required”. To date, the facility was unable to provide LPA with the ED’s current medication training documentation. Based on interviews conducted and records reviewed, the preponderance of evidence standards have been met. Therefore, the above allegations are found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies are being cited on the attached 9099-D page. Exit interview conducted. A copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Sep 24, 2025 · control 59-AS-20250723110818

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Sep 25, 2025

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility (...) by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on interviews and records reviewed, the facility assisted resident (R1) with a self-administered medication without a physician’s order, which poses an immediate health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 24, 2025

Plan of correction: Facility will conduct an in-service with staff regarding medication documentation. Facility will submit to LPA information regarding in-service training by POC due date of 9/25/25.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87208(a) · Plan of correction due date: Oct 8, 2025

87208 Plan of Operation (a) The licensee shall have and maintain a current, written definitive plan of operation for the facility. The licensee shall operate the facility in accordance with the terms specified in the plan of operation and may be cited for not doing so pursuant to Health and Safety Code section 1569.49. (…) This requirement is not met as evidenced by: Based on records reviewed, the facility did not ensure that a staff administering medications received training in accordance with the facility's Plan of Operation, which poses a potential health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 24, 2025

Plan of correction: Facility will provide LPA with a statement of understanding and submit by the POC due date of 10/8/25.

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.69(a)(1) · Plan of correction due date: Oct 8, 2025

§1569.69 Employees assisting residents with self-administration of medication; training requirements (a) Each residential care facility for the elderly licensed under this chapter shall ensure that each employee of the facility who assists residents with the self-administration of medications meets all of the following training requirements: (1) In facilities licensed to provide care for 16 or more persons, the employee shall complete 24 hours of initial training. This training shall consist of 16 hours of hands-on shadowing training, which shall be completed prior to assisting with the self-administration of medications, and 8 hours of other training or instruction, as described in subdivision (f), which shall be completed within the first four weeks of employment. This requirement is not met as evidenced by: Based on records reviewed and interviews conducted, the facility did not ensure a staff who administered a medication received the required training, which poses a potential health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 24, 2025

Plan of correction: Facility will ensure that all staff administering medications receive training in accordance with the regulations. Facility will create a plan on how to ensure staff are meeting training requirements and submit plan to LPA by POC due date of 10/8/25. Facility plans on conducting a medication management training on 9/30/25 and will submit proof of training as well.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Angela Hood arrived at the facility unannounced and met with the Executive Director, Jessica Sanders, to conduct a Required-1 Year Inspection. LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. LPA observed three (3) bedrooms in Terrace Club Memory Care, three (3) bedrooms in Reminiscence Memory Care, and five (5) common area bathrooms. LPA observed apartments to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition, properly maintained, and the hot water temperature was observed to be 113.9 degrees F. LPA checked the kitchen area for the ability to prepare and store food. Care home has required (2) two-day perishable and (7) seven-day non-perishable food supply on hand. LPA observed knives, cleaning products and other toxins to be locked away and inaccessible to residents. LPA observed the outdoor area and perimeter of the care home to be free of clutter and debris and there appeared to be no potential safety hazards to the residents in care. Smoke and carbon monoxide detectors are operational. Fire extinguishers and first aid kits are maintained and ready for emergency use. LPA checked medication storage and found medications to be locked away and inaccessible to the residents. LPA reviewed five (5) resident files and also reviewed five (5) staff files. As a result of this visit, no deficiencies were cited per California Code of Regulations, Title 22. Exit interview conducted and copy of report provided.the state’s words, verbatim · CDSS document, Jul 25, 2025

Allegation investigated: -Staff did not address residents lice infestation

Licensing Program Analyst (LPA) Angela Hood arrived at the care home today and met with the Executive Director (ED), Jessica Sanders, to deliver complaint investigation findings regarding the above stated allegation. During the course of the investigation, LPA conducted interviews, made observations, and obtained documentation pertinent to the investigation. Interviews with the ED, Resident Care Director (RCD), Memory Care Director (MCD), and staff (S1, S2, and S4) indicated that resident (R1) was observed on May 16, 2025 to have what appeared to be fleas in their hair. R1 had a pet cat in their apartment. R1's progress notes indicated that their responsible party and the primary care physician's (PCP) office were notified. Interviews with ED, RCD, MCD, S1, S2, and S4 indicated that on May 17, 2025 it was determined by the facility nurse that R1 had head lice. Interviews with ED, RCD, MCD, S1, S2, and S4 indicated that other residents were checked for head lice and were not observed to have lice. The facility received medical orders on ************************************************Continued on LIC9099-C************************************************** Unfounded May 17, 2025, May 18, 2025, and May 20, 2025 to provide R1 with lice elimination treatments to their hair. According to R1's progress notes and email correspondence between the ED and RCD, R1 received lice elimination treatments to their hair on May 17, 2025, May 18, 2025, and May 22, 2025. On May 21, 2025, with the assistance of S1, LPA observed R1's head and did not observe any active lice; however, did appear as though there may be a few eggs remaining. Facility staff agreed to complete an additional treatment. LPA did not observe any fleas, lice, or other pests in R1's room. R1's progress notes indicated that on May 22, 2025, R1 had "3 head lice treatments given with no traceable lice now". Progress notes and interviews with facility staff indicated that R1's room was cleaned on May 17, 2025. Interview with Maintenance Director indicated that they completed a deep cleaning of R1's room on May 22, 2025 using a lice treatment. Maintenance Director provided LPA a receipt for the lice treatment purchased on May 22, 2025. LPA was unable to observe R1 on a second occasion as R1 moved out of the facility on May 31, 2025. Based on interviews conducted, documentation reviewed, and observations, the above allegation is found to be UNFOUNDED. A finding that the allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. Exit interview conducted. No deficiencies are being cited.the state’s words, verbatim · CDSS document, Jul 23, 2025 · control 59-AS-20250519104944

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Angela Hood arrived at the care home today, March 20, 2025, and met with the Senior Executive Director, Janelle Odishoo, to follow-up on an SOC341 received by the department on March 12, 2025. LPA also received the facility's internal investigation findings on March 14, 2025. According to the SOC341, on March 11, 2025, the Senior Executive Director received a report from staff (S5) alleging that abuse had been reported to them from staff (S2) regarding resident (R1). S2 alleged that, during the AM shift, they witnessed staff (S1) forcefully grab R1's arms when assisting them onto the toilet on March 6, 2025. S1 had not reported the allegation to their supervisor at the time of the event. S1 was placed on leave pending an internal investigation. According to interview with the Senior Executive Director and documentation obtained, staff (S4) and staff (S6) conducted a head to toe skin check of R1 as well as all other residents residing in Reminiscence Care. All residents in Reminiscence Care have advanced stages of Dementia. S4 and S6 observed that R1 had a small bruise on their hand from a TB blood draw conducted that morning as well as some slight redness on their upper arm from the tourniquet. There were no other residents with any unusual or unexplained bruising, skin tears, or discoloration of skin. S4 and S5 interviewed S1 and S2 who provided written statements that had discrepancies regarding the incident. S4 and S5 interviewed all staff in Reminiscence Care and no interviews corroborated with S2's statement. According to interviews with staff that routinely provide care for R1, staff provide incontinence care at bedside as opposed to in the restroom, due to R1's behavioral expressions. S4 notified R1's family and physician. S4 conducted an in-service training for all three shifts regarding abuse reporting requirements, internal event reporting requirements, techniques used for ADL care and transferring for residents with dementia and behavioral expressions. LPA obtained a copy of the in-service training documentation. The facility's internal investigation was completed on 3/12/25 with Unsubstantiated findings. S1 will be re-instated to their position and returning to work March 23, 2025. LPA toured facility observing residents receiving care and participating in today's event. No concerns were observed. During today's visit, no citations are being issued. Exit interview conducted and copy of report provided.the state’s words, verbatim · CDSS document, Mar 20, 2025

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Angela Hood arrived at the facility unannounced on 5/23/24 and met with the Resident Care Director, Doreen Ntale, to conduct a Required-1 Year Inspection. LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. LPA observed five (5) bedrooms in Terrace Club Memory Care, three (3) bedrooms in Reminiscence Memory Care, and five (5) common area bathrooms. LPA observed apartments to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition, properly maintained, and the hot water temperature was observed to be 114.7 degrees F. LPA checked the kitchen area for the ability to prepare and store food. Care home has required (2) two-day perishable and (7) seven-day non-perishable food supply on hand. LPA observed knives, cleaning products and other toxins to be locked away and inaccessible to residents. LPA observed the outdoor area and perimeter of the care home to be free of clutter and debris and there appeared to be no potential safety hazards to the residents in care. Smoke and carbon monoxide detectors are operational. Fire extinguishers and first aid kits are maintained and ready for emergency use. LPA continued reviewing resident and staff documents from previous visit. As a result of this visit, no deficiencies were cited per California Code of Regulations, Title 22. Exit interview conducted and copy of report provided.the state’s words, verbatim · CDSS document, May 23, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Angela Hood arrived at the facility unannounced on 5/17/24 and met with the Doreen Ntale, Resident Care Director, to conduct a Required-1 Year Inspection. During today's visit, LPA reviewed five (5) resident files and five (5) staff files. As a result of today's visit, no deficiencies were cited per California Code of Regulations, Title 22. LPA will return at a later time to complete annual inspection. Exit interview conducted and copy of report given at the conclusion of this visit.the state’s words, verbatim · CDSS document, May 17, 2024

Allegation investigated: -Staff are not ensuring that resident's hygiene needs are being met while in care. -Staff are not allowing resident to make and receive private phone calls while in care. -Staff are not ensuring that resident is provided with a sufficient amount of food while in care. -Staff did not ensure that resident's dental needs were met while in care.

Licensing Program Analyst (LPA) Angela Hood arrived at the care home unannounced today, 5/16/24, and met with the Terrace Club Coordinator, Abby Johnson, to deliver complaint investigation findings into the above stated allegations. During the course of the investigation, LPA conducted interviews, made observations, and obtained documentation pertinent to the investigation. LPA visited resident (R1) on 1/18/24 and 2/27/24. ************************************************Continued on LIC9099-C************************************************** Unsubstantiated Allegation: Staff are not ensuring that resident's hygiene needs are being met while in care. Interviews with the Reminiscence Coordinator (RC), Terrace Club Coordinator (TCC), staff (S1), and R1’s responsible party indicated that R1 is scheduled for assistance with bathing one time per week. RC and TCC indicated that if R1 refuses showering then care staff will offer on another day or another caregiver with try to encourage bathing. S1 stated that care staff check with R1 daily to find out if R1 would like to take a shower. R1’s responsible party indicated that care staff will try different strategies to encourage R1 to take showers. Interview with R1 indicated that care staff will provide them assistance when needed. Interview with witness indicated that R1 appeared well groomed. LPA observed R1 on 1/18/24 and 2/27/24 and R1 appeared to be well groomed and wearing clean clothing. According to facility’s Documentation Survey Reports dated November 2023, December 2023, and January 2024 indicated that bathing has been provided to R1 by care staff every 2-3 days. The Documentation Survey Reports also indicated that R1 is receiving grooming and dressing assistance from care staff at least twice daily. Allegation: Staff are not allowing resident to make and receive private phone calls while in care. According to the Superior Court of Sacramento documentation dated 12/21/23, R1 is to receive and make all phone calls through a Grandpad provided by R1’s responsible party. Prior to R1 receiving the Grandpad in February 2024, RC and TCC indicated that, when incoming calls were received for R1, they would instruct callers to contact R1’s responsible party to screen calls, due to a restraining order that was granted for 5 years, dated 9/11/20, restricting all contact with R1’s family member. Interview with R1 indicated that they can receive and make phone calls. R1 indicated that they receive phone calls from family and friends. R1 stated that they don’t use the phone to call out unless it is something important. Allegation: Staff are not ensuring that resident is provided with a sufficient amount of food while in care. Interview with RC indicated that R1 mostly eats meals in the dining area. Interview with S1 indicated that R1 will order their food, eat it, forget they ate, and order more food. S1 stated that the facility keeps snacks on hand as well when residents want a snack. R1’s responsible party indicated that R1 is eating three meals per day. Interviews conducted with R1 indicated that the food is good and that they get enough to eat at the care home. LPA toured the kitchen area with the Dining Services Coordinator (DSC) and the facility has the required 2-day perishable and 7-day nonperishable food supply on hand. LPA was provided the food menus **********************************************Continued on LIC9099-C************************************************ for January-May 2024 indicating a variety of food options for the residents in care. The facility has a binder indicating any special diets in the care home. DSC indicated that they have food delivered to the care home twice per week. Allegation: Staff did not ensure that resident's dental needs were met while in care. Interview with RC and TCC indicated that the facility has a dental hygienist come to the facility frequently to provide services to the residents in care. RC and TCC indicated that R1’s responsible party was notified when the dental hygienist was in the facility. Interview with R1’s responsible party indicated that, the next time the dental hygienist is at the care home, they will have R1 seen for services. Email correspondence between the facility and R1’s responsible party indicated that R1’s responsible party would like to be contacted the next time the facility offers dental services. Interview with R1 indicated that they have gone to the dentist with their private caregiver since residing at the care home. Based on interviews conducted, documentation obtained, and observations, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Therefore, the allegations are UNSUBSTANTIATED. No deficiencies are being cited during this visit. Exit interview conducted. A copy of this report provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, May 16, 2024 · control 59-AS-20240119121758

Allegation investigated: -Staff are emotionally abusing resident in care.

Licensing Program Analyst (LPA) Angela Hood arrived unannounced at the care home today, 1/24/24, and met with the Resident Care Director, Andy Pardede, to deliver complaint investigation findings into the above stated allegation. During the course of the investigation, LPA conducted interviews and obtained documentation pertinent to the investigation. *********************************************Continued on LIC9099-C*************************************************** Unsubstantiated Interviews conducted with residents (R1, R2, & R3) indicated that care staff treat them well. R1, R2, and R3 stated that they have never witnessed staff mistreating residents in care. R2 indicated that they have never witnessed staff emotionally abusing any residents and that they would say something if they saw something. R3 stated that they have never witnessed any type of abuse from staff towards residents in the care home. Interviews with staff (S1 & S2) indicated that they have never witnessed staff emotionally abusing residents in care. Interview with staff (S3) indicated that they have never witnessed any type of abuse from staff towards residents in care. S3 indicated that they have never witnessed staff mistreating residents. S2 indicated that residents are treated respectfully and with dignity. Based on interviews conducted, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is UNSUBSTANTIATED. No deficiencies are being cited during this visit. Exit interview conducted. A copy of this report provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Jan 24, 2024 · control 59-AS-20231204110215

Allegation investigated: -Staff did not give resident's medication as prescribed

Licensing Program Analyst (LPA) Angela Hood arrived at the care home today, 12/20/23, and met with Barbara Barron, Senior Executive Director, to deliver complaint investigation findings into the allegation that staff did not give resident's medication as prescribed. During the course of the investigation, LPA conducted 2 medication counts and obtained documentation pertinent to the investigation. Allegation: Staff did not give resident's medication as prescribed During a visit conducted on 10/25/23, LPA conducted a medication count for residents (R1, R2, & R3), comparing the residents' medication lists on file with medication centrally stored for the residents. LPA observed two (2) medications for R1 that were off count in relation to what was documented. One medication was over the amount documented and the other was under the documented amount. ********************************************Continued on LIC9099-C************************************************** Substantiated LPA observed two (2) medications for R2 that were off count and were under the amount documented and one (1) medication that was over the amount documented. LPA observed that R3 had one (1) medication that was off count and over the documented amount. There were several of R1, R2, and R3's medications that were not observed during the first medication count conducted. During a visit conducted on 12/14/23, LPA conducted a medication count for R1, R2, and R3 comparing the residents' medication lists on file with medication centrally stored for the residents. LPA observed one (1) medication for R1 that was off count in relation to what was documented and was over the amount documented. LPA observed one (1) medication for R2 that was off count and was over the documented amount. No medication refusals were provided for either medication counts conducted on 10/25/23 and 12/14/23. According to R1's medication list, R1 is prescribed to receive Insulin before meals. Interviews conducted with staff (S3, S4, & S5) indicated that they were on duty during the brunch event the facility held on 8/27/23. S3, S4, and S5 recall that there were no nurses on duty during the morning shift on 8/27/23. The nurse scheduled (S2) came in after the brunch event. According to the schedule provided to LPA, S2 was the only nurse scheduled on 8/27/23. S2 was scheduled for the PM shift starting at 2pm. S3 indicated that R1's responsible party was concerned that R1 had not received their insulin injection prior to mealtime as prescribed. Interview with S3 indicated that they spoke with S4 regarding R1's responsible party's concern regarding the insulin medication. Interview with S4 and S5 indicated that they assisted each other with providing insulin injections using the hand-over-hand method for any residents requiring insulin injections. S4 and S5 both recall that R1's insulin medication may have been given late during the brunch event on 8/27/23. Based on interviews conducted, a medication count, and records reviewed, the preponderance of evidence standards have been met. Therefore, the above allegation is found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D page. Exit interview conducted. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents. facility has a total of 5 nurses that work at the facility. ED indicated that there are only two Med Techs that have been used for insulin injections in an emergency situation. Interviews with staff (S1 & S2) indicated that the nurses at the facility can assist residents with insulin injections. Interviews also indicated that the Med Techs who are trained to assist residents with injections use the hand-over-hand method. S1 stated that the residents understand how to do their own injections with hand-over-hand assistance from a Med Tech. S2 stated that some residents require more assistance with injections than the hand-over-hand method and a nurse would provide the assistance. The facility provided LPA with training documentation indicating that the two staff (S4 & S5) utilized to assist with hand-over-hand injections have completed medication training. The facility also provided documentation indicating that the 5 vocational nurses have current licenses through the Board of Vocational Nursing and Psychiatric Technicians. Based on interviews conducted and documentation reviewed, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Therefore, the allegations are UNSUBSTANTIATED. No deficiencies are being cited during this visit. Exit interview conducted. A copy of this report provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Dec 20, 2023 · control 59-AS-20230830171650

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Dec 21, 2023

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility (...) by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on medication counts and records reviewed, the facility did not ensure that residents (R1, R2, & R3) were receiving medications as prescribed, which poses an immediate health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Dec 20, 2023

Plan of correction: Facility agrees to have all med-techs and nurses sign a statement of understanding of job duties to address medication management to submit to LPA by the POC due date of 12/21/23. Faciliy will also complete bi-weekly audits of all medications for the next month and submit to LPA.

Allegation investigated: Staff violated resident's personal rights.

On 12/7/23, Licensing Program Analyst (LPA) Kevin Mknelly spoke with Barbara Barron, Senior Executive Director/ Interum Administrator, to deliver complaint findings for the above allegation. LPA reviewed resident records, facility records and conducted interviews. LPA finds that the allegations cited above are substantiated. Staff violated resident's personal rights- Between R1’s admission on 11/30/22 and 3/7/23, R1 was regularly visited at the facility by a well known friend. On 3/8/23, an incident occurred at the facility where police responded to assess R1’s wellbeing. The Police determined that R1 was not being harmed by facility staff. R1’s Conservator requested, to the police officer, that the friend be escorted from the property. According to Sunrise Progress notes for R1, R1’s Conservator stated to the facility Executive Director (ED) that the Conservator would pursue a court order to limit the friend’s access to visit R1. During this investigation, the licensee was unable to provide proof that the Conservator had a court order to limit individuals’ visitation to R1, nor was there a police issued restraining order. Substantiated noted changes in function of increased pain. Constipation was noted noted in Progress notes on 3/15/23. Again, R1's activity, function and food intake were unchanged. On 3/18/23, R1 was observed to be experiencing: lethargic, low food intake, weakness, finger injured swollen. The facility initiated medical evaluation. The facility staff were notified on 3/19/23 by the hospital, that R1's "kidneys do not look good." (R1 had a prior history of kidney disease.) On 3/25/23, progress notes noted a call from hospital that R1 was now experiencing dehydration. When R1 returned to the facility on 4/29/23, that R1's weight was then 142 lbs. LPA made repeated attempts to obtain Hospital records. The hospital records were not released to this LPA. Therefore, conditions at hospital admission nor the course of R1's care while hospitalized could not be confirmed. Care plan and care notes showed care provided as agreed to. As a result of this investigation, LPA finds allegation to be (US)Unsubstantiated - A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview with administrator. However, the Sunrise Service Plan, provided to LPA, regarding R1 states (the friend) is not allowed on Sunrise property- call the sheriff and Conservator if (the friend) comes to Sunrise. As R1’s Service Plan states such a visitation restriction and it was based on a direction from R1’s Conservator, who did not have legal ground to set such limitations, this allegation is substantiated. R1 was allowed other visitors and progress notes did not note requests for the friend nor was there a change noted to R1’s overall emotional status as a result of the lack of (the friend) visitation. As a result of this investigation, LPA finds allegation to be (S) Substantiated - A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. The following deficiencies were cited on 9099-D, per Title 22 Regulations, Division 6. (A)This poses an immediate Health and Safety risk to clients/residents in care. (B) This poses a potential Health and Safety risk, or personal rights violation, to clients/residents in care. Report reviewed with Barbara Barrob . Copy of this report and appeal rights provided.the state’s words, verbatim · CDSS document, Dec 7, 2023 · control 59-AS-20230616114554

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(11) · Plan of correction due date: Jan 4, 2024

Personal Rights of Residents in All Facilities (a) (11) To have their visitors, including ombudspersons and advocacy representatives, permitted to visit privately during reasonable hours and without prior notice, provided that the rights of other residents are not infringed upon. This requirement was not met based on statements and records. This posed a potential risk to R1.the state’s words, verbatim · CDSS document, Dec 7, 2023

Plan of correction: Licensee will submit proof of training of all staff regarding the rights of resident visitation and the conditions under which visitation may be restricted by others. The training content and proof of training will be submitted to this LPA by the POC date of 1/4/24.