Sunrise at Canyon Crest

Type of visit: Required - 1 Year

n 7/21/2023, Licensing Program Analyst (LPA) Janette Romero conducted an unannounced visit to the facility for a required annual inspection. LPA met with Administrator Heather Segura who was informed of the purpose of the visit. LPA toured the facility’s interior and exterior with Administrator Segura. The facility is made up of three (3) cottages, two (2) of which are designated for assisted living and one (1) for memory care. The facility is licensed for 88 non-ambulatory residents of which three (3) may be bedridden. The memory care unit is approved for delayed egress. During the tour, LPA tested the delayed egress and observed it to be operational. Facility has a hospice waiver for 20 residents and Administrator Segura stated the facility currently has 13 residents on hospice. The facility has large dining rooms, kitchen, and other areas throughout the building for residents to sit and relax. The outside area provides shaded seating available for resident use. Indoor and outdoor passageways are free of obstruction. LPA observed fire alarm systems, carbon monoxide detectors and fire extinguishers throughout the cottages. There are no bodies of water on the premises. Food was stored in a safe and healthful manner. Facility met Departmental requirements for 2-day perishables and 7-day non-perishable food items. Resident interviews revealed kitchen staff accommodate residents’ dietary needs. There are several activities and outings available for resident leisure. Medications are secured in medication carts, only accessible to authorized personnel such as wellness nurses and/or MedTechs. Cleaning solutions, knives and sharp instruments are secured and inaccessible to the residents. Fireplaces have appropriate barriers to make them inaccessible for residents. During this visit, LPA did not observe any deficiencies. A copy of this report was discussed and provided to Administrator Segura.the state’s words, verbatim · CDSS document, Jul 21, 2023

Allegation investigated: Resident sustained multiple fractures while in care. Staff caused resident to fall resulting in an injury . Staff failed to respond to residents alerts in a timely manner. Staff mishandled resident's medication. Staff failed to assist resident with toileting needs . Staff failed to ensure residents were properly fed while in care

Licensing Program Analyst (LPA) Rayshaun Nickolas visited the facility unannounced to deliver the finding on the above allegations. LPA met with Executive Director Heather Segura and explained the purpose of the visit. These allegations were investigated by department staff. LPA Nickolas reviewed the facility files and conducted an additional interview with a facility staff member. On May 12, 2020, due to COVID-19 protocols, LPA Shaunte Henry initiated the ten-day telephone complaint investigation into the alleged allegation that "Resident sustained multiple fractures while in care”. The allegation alleged that resident # 1 (R1) sustained multiple fractures while in care due to facility staff neglect & lack of care and supervision. Department staff interview of facility staff members revealed that R1 was receiving physical therapy throughout the years at the facility. Physical therapy was recommended to build R1's strength, and as R1's strength improved, R1 would instead do things independently than ask for assistance Unsubstantiated The interview of facility staff members revealed that a few of the falls R1 had throughout the years were due to them doing things independently and not asking for help. The interview of facility staff members revealed that R1 resided in assisted living and did not require additional room checks. Assisted living residents are checked by their caregiver every two (2) hours unless a pendant or pull cord is activated. Department staff interview with R1 revealed that their first fall at the facility resulting in a fracture, was their fault because they were walking too fast while using their walker. R1 stated that they could not get off the floor on the second fall (which also resulted in a fracture). R1 could not provide the date of that fall, nor did R1 remember what they were doing when they fell. However, when asked if they called for assistance, R1 responded, "they did not need to because, at that time, they did things on their own". Department staff file review revealed that R1 received emergency and continuous medical care until they recovered from their injuries. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation. Allegation #2 “Staff caused resident to fall resulting in an injury”. The allegation alleged that sometime in February 2020, resident # 1 (R1) returned to their room from lunch and used their walker with staff # 3 (S3) as an escort. The allegation alleged that R1 asked S3 not to let them fall because they felt unsteady. S3 let go of R1 to open the door, and R1 fell. Department staff interview with the reporting party (RP) revealed that R1 sustained a cut on their left knee and some soreness. Department staff interview with R1 revealed that S3 let go of them for a second, and they went down. R1 was unable to provide further details about this fall. Department staff interview with S3 revealed that on February 18, 2020, S3 was escorting R1 back to their room from lunch. S3 stated that R1 was using their walker, and when they got to their room, R1 stated they felt dizzy and tired. S3 described R1 as falling as their head and body tilted to one side. S3 stated they responded immediately, placed their arm around R1 as if hugging R1, and guided R1 down to the floor. S3 stated that R1 did not hit the floor because they could lay them down. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation. Allegation # 3 “Staff failed to respond to residents’ alerts in a timely manner”. The allegation alleged that on April 11, 2017, R1 pushed their call button and waited for over 15 minutes for assistance. LPA Nickolas’ review of the facility log report on April 11, 2017, revealed that R1 activated their call button nine (9) times, and the facility staff responded in less than 15 minutes seven (7) out of (9) times. Two (2) times, facility staff responded long than 15 minutes; facility staff responded in 18 minutes at 3:01 p.m. and 16 minutes at 8:35 p.m. The allegation alleged that on April 9, 2020, R1 was left unattended in the bathroom for over 20 minutes. The allegation alleged that R1 pressed their call button several times. LPA Nickolas’ review of August 9, 2020, facility log report revealed that R1’s call button was activated three (3) times. The facility staff responded in two (2) minutes the first time the call button was activated on April 9, 2020. One (1) minute the second time the call button was activated on April 9, 2020, and eight (8) minutes the third time the call button was activated on April 9, 2020. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation. Allegation # 4 “Staff mishandled resident’s medication”. The RP alleged that the facility misplaced R1’s medication and could not find it until two (2) days later. LPA Nickolas’ reviewed R1’s Medication Administration Records (MARs), which revealed that R1’s medication was administered per the physician’s orders. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation. Allegation #5 “Staff failed to assist resident with toileting needs” The allegation alleged that on July 29, 2017, R1 was taken to the restroom and sat on the toilet after pushing their call button for 35 to 40 minutes for the facility staff to return to assist them. LPA Nickolas’ reviewed the facility log report on July 29, 2017 and revealed that staff responded to R1’s call button in less than 10 minutes. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation. Allegation #6 “Staff failed to ensure residents were properly fed while in care”. The allegation alleged that on February 28, 2018, R1 did not receive breakfast and pushed their call button to inquire. Facility staff arrived, and R1 reported they missed breakfast, and the facility staff left and never returned. The allegation alleged that on March 19, 2020, R1 pushed their call button to report they did not get lunch. When unknown facility staff arrived, and R1 informed them that they did not receive lunch, R1 was advised that lunch was over. The unknown facility staff offered R1 fruit but did not bring R1 the fruit requested. LPA Nickolas’ interview with staff # 4 (S4) revealed that if a client cannot make dining services, the meal is held for them unless the client declines to eat. However, facility staff will also provide food to clients in care whenever a client announces they are hungry. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation. A finding of Unsubstantiated means 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. An exit interview was conducted and copy of this report was provided. Based on the evidence gathered during the investigation, the above allegation is Substantiated. A finding that the complaint is Substantiated means that the allegation(s) is valid because the preponderance of the evidence standard has been met. An exit interview was conducted where a copy of this report (LIC 9099), LIC 9099D, and appeal rights were discussed and provided.the state’s words, verbatim · CDSS document, May 4, 2023 · control 18-AS-20200504123240

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(a) · Plan of correction due date: May 19, 2023

87411 Personnel Requirements-General (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 evidenced by: Based on interviews, the facility staff did not ensure the riser was placed on the toilet to prevent R1 from falling, which is a potential health, safety, personal rights violation to persons in care.the state’s words, verbatim · CDSS document, May 4, 2023

Plan of correction: The licensee shall provide full training to all staff on proper use of asisted devices, and proper placement before resident care. The Licensee shall submit training records to the Regional Office (RO) by the POC due date.

Allegation investigated: Licensee not following infection control requirements Licensee not providing resident with healthful accommodations

Licensing Program Analyst (LPA) Jesse Gardner arrived unannounced to conduct an investigation into the allegations listed above. LPA met with Administrator Heather Segura and explained the purpose of the visit. LPA conducted a tour of the facility. It was alleged that Staff One (S1) gave Resident One (R1) their toothbrush without washing R1's hands after assisting them utilizing the commode. It was further alleged that feces was found on R1's toilet, and blood on R1's sheets, and pillowcase. Continued on LIC9099-C. Unsubstantiated Through observation, LPA found that R1's room is in immaculate order. There was no infection control concern upon LPA inspection. No feces, or blood was found. Through interview with staff, Resident One (R1), and confidential witness, LPA found that there were conflicting accounts of the incident with no other witnesses present. Thus, this allegation is UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means that 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. An exit interview was conducted, where a copy of this report was discussed and provided to Administrator Segura along with a copy of the LIC811 (confidential names list).the state’s words, verbatim · CDSS document, Feb 15, 2023 · control 18-AS-20230207140950

Allegation investigated: Facility administering medication without prescription

Licensing Program Analyst (LPA) Jesse Gardner arrived unannounced to the facility to deliver findings to an investigation into the above allegation. LPA arrived and met with Business Office Coordinator Eden Rivera and advised the purpose of the visit, and toured the facility. Regarding the allegation, "Facility administering medication without prescription", LPA conducted interviews with staff, and reviewed, and took copies of pertinent documents. The investigation revealed that the facility, in fact, had a prescription for the THC/CBD oil, and were administering to Resident One (R1) as ordered by the physician. Unfounded As such, the allegation was found to be UNFOUNDED. LPA determined that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted and a copy of this report was discussed with and provided to Executive Director Heather Segura along with a copy of the LIC811.the state’s words, verbatim · CDSS document, Oct 10, 2022 · control 18-AS-20220927104542

Type of visit: Required - 1 Year

On 07/26/2022, Licensing Program Analyst (LPA), Venus Mixson arrived at the above facility for an unannounced required annual with emphasis on infection control. LPA Mixson was greeted and granted entry by Administrator, Heather Segura. LPA Mixson met with Administrator introduced self and stated the purpose of the visit. Present in the facility were 66 residents and 11 caregivers. There are currently no cases of COVID-19 within the facility. LPA Mixson toured the facility and made observations pertaining to the facility's infection control measures. LPA observed sufficient hand hygiene supplies, sufficient cleaning and disinfecting provisions and the proper use of face coverings. The facility has a designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases, ensuring PPE supplies are maintained, and cleaning and disinfection provisions are in adequate quantities. LPA Mixson later discussed infection control practices and procedures with Administrator. An exit interview was conducted, and a copy of this report along with the LIC 811 was provided to Administrator.the state’s words, verbatim · CDSS document, Jul 26, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Yolanda Delgado made an unannounced visit to the facility to conduct an annual inspection with an emphasis on infection control. LPA arrived at 11:20 AM, LPA was met by Assisted Living Coordinator Andrea Clark and explained the purpose of the visit. Present in the facility during time of visit were twenty-six (26) staff as well as sixty-eight (68) residents. There are currently no cases of COVID-19 within the facility. 65 of 68 residents are fully vaccinated and 81 of 85 staff are fully vaccinated. During today's visit, LPA toured the facility and made observations pertaining to the facility's infection precautions with insufficient signage, minimum hand hygiene supplies, sufficient cleaning and disinfecting provisions, and proper use of face coverings for staff. The facility has a designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases, ensuring PPE supplies are maintained, cleaning and disinfection provisions are in adequate quantities, and that staff are trained in the proper use and disposal of PPE and overall infection control. The facility has a plan in place which follows Community Care Licensing guidelines for when and how long to test staff and residents for COVID-19, when and how to isolate/quarantine residents, and when to schedule cleaning and disinfection times of high traffic and frequently touched areas. The facility also has a plan in place to monitor resident(s) regularly for any changes in condition and to subsequently notify the resident(s) physician and to notify all emergency agencies in the event of any COVID-19 related and/or suspected illnesses. Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code or Regulations. An exit interview to review this report was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Sep 16, 2021