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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 045003003
Report Date: 11/07/2024
Date Signed: 11/07/2024 09:53:26 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/09/2024 and conducted by Evaluator Donna Gurriere
COMPLAINT CONTROL NUMBER: 59-AS-20240909092208
FACILITY NAME:SUNSHINE ASSISTED LIVING- THE COTTAGEFACILITY NUMBER:
045003003
ADMINISTRATOR:FENNEL, LISAFACILITY TYPE:
740
ADDRESS:1468 SUN MANORTELEPHONE:
(530) 887-3363
CITY:PARADISESTATE: CAZIP CODE:
95969
CAPACITY:17CENSUS: 15DATE:
11/07/2024
UNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:LISA FENNELTIME COMPLETED:
10:00 AM
ALLEGATION(S):
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Facility failed to address resident's health and medical care needs during their stay from 02/2024 until 08/2024.

Resident's dietary needs were not met.
INVESTIGATION FINDINGS:
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On 11/07/24 Donna Gurriere, Licensing Program Analyst (LPA) arrived at the facility unannounced to deliver final findings regarding a complaint that was received on 09/09/24. LPA Gurriere met with Lisa Fennel, Administrator and explained the purpose of the visit.

Facility failed to address resident's health and medical care needs during their stay from 02/2024 until 08/2024.

During the interview process, the administrator and seven staff persons were interviewed. It is noted that the previous administrator has resigned from her position and the new administrator was in training when the resident (Resident 1) was residing at the facility. The resident was not interviewed as he has since moved. In addition, documents were obtained to include the Physician’s Report, the Individual Program Plan (IPP), Preplacement Appraisal, Medications List and Service Plan.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Donna Gurriere
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 59-AS-20240909092208
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: SUNSHINE ASSISTED LIVING- THE COTTAGE
FACILITY NUMBER: 045003003
VISIT DATE: 11/07/2024
NARRATIVE
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During the investigation, it was reported that the resident was not seen by the podiatrist to have his toenails clipped. It was stated by all staff that the podiatrist came to the facility once a month to address podiatry needs. It was reported that the podiatrist came to the facility on short notice and those residents that were present had their podiatry needs met. The resident (Resident 1) attended day program five days a week and therefore did not meet with the podiatrist. When interviewed, staff reported that they did not see the resident’s toenails to make the recommendation for him to see the podiatrist.

Although the above allegation mentioned may have happened, or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the above findings are Unsubstantiated.

Resident's dietary needs were not met.

During the interview process, the administrator and seven staff persons were interviewed. It is noted that the previous administrator has resigned from her position and the new administrator was in training when the resident (Resident 1) was residing at the facility. The resident was not interviewed as he has since moved. In addition, documents were obtained to include the Physician’s Report, the Individual Program Plan (IPP), Preplacement Appraisal, Medications List and Service Plan.

During the investigation, documents were reviewed to include the Physician’s Report, the IDP and the Service Plan. Of those three documents there was nothing to indicate that the resident was on a “Special Diet.” On the Physician’s Report the physician checked “No special diet,” and on the Service Plan it states, “No assistance with meal reminders or feeding support.”


continued
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Donna Gurriere
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 59-AS-20240909092208
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: SUNSHINE ASSISTED LIVING- THE COTTAGE
FACILITY NUMBER: 045003003
VISIT DATE: 11/07/2024
NARRATIVE
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The cook stated that she was advised by the family to ensure that the resident received healthy meals to include low carbohydrates, fruit, and veggies. The cook stated that she provided a lunch box for the resident five days a week when he went to his day program and that she gave him a sandwich, fruit, and veggies each day. Other staff interviewed advised that they were not aware of a special diet that they were to monitor. It was indicated that the family requested that the resident be provided with healthier foods, due to his edema, such as vegetables rather than “junk food” to include not having various types of potato chips; however, there was nothing written in the resident’s file to state that he was on a special diet.

Although the above allegation mentioned may have happened, or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the above findings are Unsubstantiated
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Donna Gurriere
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3