345002828-10-24-2024-59-AS-MSEY-DAGPW3-20241028114003

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 345002828
Report Date: 10/24/2024
Date Signed: 10/24/2024 04:47:47 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
07/31/2024 and conducted by Evaluator Sabrina Calzada

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20240731165518

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:	6	CENSUS: 6	DATE:	10/24/2024
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Anita Heydon, Administrator, and Steve Heydon, Administrator, Designee		TIME COMPLETED:	04:55 PM

ALLEGATION(S):

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Staff interacted with resident in a physically rough manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to deliver findings to the above allegation for a complaint received on 7/31/24. LPA met with Anita Heydon, Administrator, and Steve Heydon, Administrator Designee, stating the reason for today's inspection. Also present was staff, Ram Pratap.

During the course of the investigation, LPA interviewed the Administrator, Administrator Designee, (1) facility staff, (2) residents, resident (R1) and their family member. LPA reviewed documentation, including (R1's) physician's report and admission agreement,

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: 10/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 59-AS-20240731165518

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: 10/24/2024

NARRATIVE

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9099C-1..Allegation: Staff interacted with resident in a physically rough manner. The allegation states that when resident (R1) was admitted to the Emergency Room on 7/28/24, for chest pain. Resident stated a staff member interacted roughly with her, grabbing her arm and wrist, when she tried to take a paper towel from the kitchen area, and redirected her back to her room. No visible injuries were noted following the incident for chest pain.

Resident's physician's report documents that (R1) has a diagnosis of hypertension, kidney disease, bilateral hearing loss, vision blurriness. Additionally, the report notes (R1) is "extremely hard of hearing", wears glasses, and has motor impairment/paralysis.

The Administrator Designee and Administrator both stated they were not present on 7/28/24, when the incident happened, since it was on a Saturday/weekend and that (R1) was looking for another care home with a bigger room. The Administrator stated she believes (S1) was on the phone when resident (R1) entered the kitchen to grab a paper towel, explaining (S1) gently pushed (R1) away from the stove, since there was soup cooking on the stove.

Staff (S1) confirmed they were on shift on 7/28/24 when the incident occurred and explained that (R1) "suddenly ran to grab a paper towel" while there was soup cooking on the stove. (S1) stated he "moved her (R1) " touched her shoulder to redirect her", explaining (R1) had "hearing problems". (S1) further stated (R1) "got mad" at him and he is not sure why resident needed a paper towel as she would regularly take napkins into her room. (S1) explained that (R1) did not have a diagnosis of Dementia, but he "worried she was using one hand to tear the paper towel" and she could have fallen doing so.

Resident's family member stated (R1) "does not hear well at all, has a short fuse and has a complex" that everyone is out to get her. The family member stated she is familiar with this incident and described when (R1) "got angry" at a staff when she went in the kitchen and he told her she cannot go in there. The family member visited (R1) twice during her stay and felt the facility and staff were not negligent.

Resident (R1) stated to LPA that she recalls the incident on 7/28/24. R1 stated she was resting on the couch in the common area and (S1) asked her to nap in her room. After getting up, (R1) stated she grabbed one of the "regular paper towels" from the kitchen and staff (S1) became upset and physically redirected her out of the kitchen. (R1) stated she felt (S1) was upset she had entered the kitchen and stated the stove was not currently being used to cook soup or anything else. (R1) stated she grabbed (S1) back and swung at him.
*cont on 9099C-2..

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024

LIC9099 (FAS) - (06/04)

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Control Number 59-AS-20240731165518

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: 10/24/2024

NARRATIVE

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9099C-2.. Resident (R1) stated she went back to her room and (S1) took her temperature which showed she had a fever. (R1) stated she grabbed a paper towel from the kitchen as the paper towels in the bathroom are "too difficult to access". (R1) confirmed she was not injured, including any bruising, from the incident, and was sent to the emergency room due to a high temperature and pulse.

LPA observed the paper towel dispenser to be a center-pull dispenser, or the kind where the towel has to be pulled out. The Administrator stated that residents are able to access the paper towels without a struggle.

LPA attempted to interview (2) other residents who were present during the incident; however, neither resident could recall the incident, or any helpful information about (R1).

Administrator agrees to post a sign stating when food is being prepared so residents are aware. The kitchen has a counter side that residents can always access.

Based on information obtained, LPA finds the 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: 10/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024

LIC9099 (FAS) - (06/04)

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