345002828-11-9-2023-59-AS-MSEY-DAPNYC-20241104095225

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 345002828
Report Date: 11/09/2023
Date Signed: 11/09/2023 02:25:03 PM

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
08/09/2023 and conducted by Evaluator Sabrina Calzada

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20230809091944

FACILITY NAME:	SUNRISE SENIOR CARE		FACILITY NUMBER:	345002828
ADMINISTRATOR:	HEYDON, ANITA		FACILITY TYPE:	740
ADDRESS:	6729 SUGAR MAPLE WAY		TELEPHONE:	(916) 745-4167
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95610
CAPACITY:	5	CENSUS: 5	DATE:	11/09/2023
		UNANNOUNCED	TIME BEGAN:	01:50 PM
MET WITH:	Steve Heydon,		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Neglect/Lack of Care and Supervision- Staff ignored resident's calls for assistance
Staff does not serve food in consideration of resident's religious background.
Staff violated resident's religious rights.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to deliver partial complaint findings to a complaint received on 8/9/23. LPA met with Steve Heydon, caregiver/Administrator Designee, and explained purpose of inspection. Also present was Ram Pratap, caregiver.

During the investigation, LPA interviewed the Administrator, (2) caregivers at this facility and (2) caregivers at a related facility where resident (R1) lived prior to transferring to this facility. LPA reviewed documentation pertaining to (R1) including, but not limited to, hospice medication records, patient agreement, hospice assessment and plan of care and facility personnel report.

The results of the investigation are as follows:

cont on 9099C-1..

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023

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 5

Control Number 59-AS-20230809091944

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: SUNRISE SENIOR CARE	FACILITY NUMBER: 345002828
	VISIT DATE: 11/09/2023

NARRATIVE

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9099C-1... Allegation: Neglect/Lack of Care and Supervision- Staff ignored resident's calls for assistance. Complaint alleges that NOC shift staff, (S1), ignored resident's calls for assistance, stating "he is not paying enough" to answer his calls.

The Administrator stated on 8/17/23 she had never heard staff (S1) state that (R1) was not paying enough for staff to answer his call button and asserted that (R1) "locked several iPhones" and so would use the call button to request assistance from staff.

(S1) confirmed with LPA on 8/17/23 that he knew prior resident, (R1), stating (R1) lived at the facility for approximately 5-6 months. (S1) indicated he would regularly check on (R1) and change him as needed, and sometimes (R1) would ask for hep in the middle of the night, between 2-3 am, and confirmed he (S1) was awake until until around 11:00 pm when all residents were asleep. (S1) asserted, "he was well cared for at night and during the day" and never needed a second care person adding that "(R1) would ask for candies and sometimes wanted to sit in a wheelchair in the morning". (S1) was adamant that he never said (R1) was not paying enough to answer his calls, commenting that (R1) was taken to appointments and staff used ointments on his skin. (S1) confirmed he provided ADL's including feeding, changing and administering PRN meds to (R1) and sometimes assisted "am" staff with transferring (R1) and using the hoyer lift, and the daytime care staff provided bathing to (R1).

(S1) stated that over the last 3-4 weeks, before he passed, (R1) was "not clear in his speech" and that previously before declining, (R1) could use his cell phone, the call button and move himself from side to side, but about 4-5 weeks ago, (R1) forgot his password on his cell phone and it became "locked".
(S1) stated that over the last month, (R1) was not able to ask for help as he "slowed down, especially with his movement". Hospice records show (R1) was admitted on 7/27/23.

LPA was unable to contact staff (S2) who also worked at the facility when (R1) lived there,to speak with him regarding the allegation.

Based on interviews conducted, LPA finds the above allegation to be UNSUBSTANTIATED. A finding that a complaint allegation 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.
9099C-2...

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 59-AS-20230809091944

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: SUNRISE SENIOR CARE	FACILITY NUMBER: 345002828
	VISIT DATE: 11/09/2023

NARRATIVE

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9099C-2... Allegation: Staff does not serve food in consideration of resident's religious background.
Complaint alleges that staff continue to serve resident (R1) pork (bacon, ham and pork and beans) which is not permitted under the Muslim religion.

The Administrator Designee/caregiver stated on 8/17/23 that (R1) was not supposed to eat pork and staff was aware that (R1) shouldn't be served pork and staff was "able to give other things". This staff was adamant that (R1) "was not served any other food" with pork and he had a discussion with staff about this, explaining that ever since (R1) moved to this location from a related facility, (R1) requested to not be served pork, so staff would mostly serve (R1) chicken, fish and turkey bacon. LPA was shown a package of turkey bacon in the refrigerator during the interview and confirmed it to be 100% turkey meat. LPA also observed an almost finished bag of frozen turkey sausage links. This staff confirmed that the facility does buy and serve "pork and beans", but it was "never served to (R1) to my knowledge".

The Administrator stated on 8/17/23 that (R1) used to order his own food and "he had a lot of food in his room". The Administrator explained that (R1) "was going back and forth" between being a Christian and Muslim and (R1) did ask for pork as he was told it's okay by an Islam guy who visited him (R1). The Administrator said she called the Muslim priest and told him (R1) is still asking for pork, and was told "it's okay, it will take him time to change". The Administrator commented (R1) was "served turkey bacon and sausage and because he (R1)) loved pork bacon and sausage so much, he went on a hunger strike" telling staff, "I'll stop eating pork next week".

(S1) explained that when (R1) moved in, he ate "normal food" like "fried eggs and toast",but the last 2-3 weeks (R1) lived, it was hard for him to swallow, even water, and he called hospice out. (S1) stated "No, (R1) never said he didn't want pork, but Steve told me he didn't want any", explaining that most of the time, normally chicken and meatballs are served to residents and they don't use bacon much, stating it has too much grease in it. A staff at a related facility stated (R1) could eat anything and did not have any food preferences while living there; a second staff stated (R1) liked to eat - a lot of food and did not have any restrictions when she worked with him and confirmed (R1) "used to eat pork"

Based on interviews conducted, LPA finds the above allegation to be UNSUBSTANTIATED. A finding that a complaint allegation 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.
cont on 9099C-3...

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 59-AS-20230809091944

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: SUNRISE SENIOR CARE	FACILITY NUMBER: 345002828
	VISIT DATE: 11/09/2023

NARRATIVE

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9099C-3...Allegation: Staff violated resident's religious rights. Complaint alleges facility staff violated resident's Muslim rights.

The Administrator Designee/caregiver, stated on 8/17/23,"I didn't know about a conversion either way" and explained that he found out about (R1) converting to Islam after he passed, explaining there was one caregiver at the related facility who converted (R1) to Islam. This staff stated that it was his understanding that "sometime in the spring, he (R1) converted back to Christianity which was news to us", asserting "we really didn't know what his religious preference was". Staff (S1) was interviewed and stated "No, he never mentioned his religious preference- I think he had a Bible in his closet". The Administrator stated on 8/17/23 she has no documentation of (R1) changing to Islam religion and commented "it happened probably" at the related facility. One staff who works at a related facility commented that she believes (R1) "used to be Christian and was converted to Islam by a staff member". A second staff at that facility stated "I heard" (R1) was converted to Islam", but she is not sure if it's true as she went on leave for several months in 2023.

LPA reviewed admission paperwork for (R1), specifically LIC601, dated 8/18/22, which does not list any religious preference. The Administrator Designee stated that on 8/8/23, someone from the Mosque talked to (R1). LPA was provided with copies of Home Health notes entered on 8/10/23, by the Chaplain indicating that (R1) was Muslim and converted to Christianity under his (Chaplain's) care. (R1) began receiving hospice services on 7/27/23 and passed on 8/9/23. Notes were entered by the Hospice Chaplain on 7/28/23, when the initial assessment was made. Notes say that (R1) is Christian. There are nursing notes entered on 8/3/23 and on 8/5/23.

The Administrator stated (R1) "was going back and forth" between being a Christian and Muslim and he called the Chaplain through the hospice company to say he wanted to be a Christian, adding (R1) said he wanted to eat pork as he was told it's okay by an Islam guy who visited him (R1). The Administrator asserted "Everything came as a surprise and without me- it never happened with me there" and stated the Chaplain spoke to her months back, when (R1) was previously on hospice in May, and (R1) was Christian at that time and commented "I was never sure what to do".

Based on interviews conducted, LPA finds the above allegation to be UNSUBSTANTIATED. A finding that a complaint allegation 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. Copy of report provided to the facility.

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023

LIC9099 (FAS) - (06/04)

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