345920097-9-26-2024-59-AS-KHOS-D9LKJU-20240930075720

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 345920097
Report Date: 09/26/2024
Date Signed: 09/26/2024 05:16:21 PM

Unfounded

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
09/24/2024 and conducted by Evaluator Sabrina Calzada

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20240924145658

FACILITY NAME:	SUNRISE RANCH CARE HOME		FACILITY NUMBER:	345920097
ADMINISTRATOR:	UGBO, BLESSING		FACILITY TYPE:	740
ADDRESS:	8225 EVA RETTA CT		TELEPHONE:	(916) 633-6662
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95610
CAPACITY:	6	CENSUS: 6	DATE:	09/26/2024
		UNANNOUNCED	TIME BEGAN:	04:00 PM
MET WITH:	Blessing Ugbo, Administrator		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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Staff administered medication to resident without a physician's order.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a 10-day inspection for a complaint received on 9/24/24. LPA met with Blessing Ugbo, Administrator, and stated the reason for today's inspection. LPA and Administrator toured the facility, which was observed to be clean, safe and in good repair. The Ombudsman arrived at 3:00 pm, unannounced also, to investigate the same allegation.

LPA and the Administrator reviewed documentation from resident (R1's) file, contacted another staff member by phone, and reviewed an order for thickened liquid and puree food written on the 9/18/24. The results of the investigation are as follows:

The allegation states that staff (S1) stated she gave resident (R1) an over-the-counter thickening powder, without an order, since resident was prone to chocking. The allegation states the medication was given without a presription order for (R1) but that the facility had the powder on hand for another resident.

cont on 9099C-1...

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024

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-20240924145658

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 RANCH CARE HOME	FACILITY NUMBER: 345920097
	VISIT DATE: 09/26/2024

NARRATIVE

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9099C-1.. The Administrator stated when she conducted (R1's) assessment, on/around 8/30/24, (R1) was observed to have slight coughing but no choking, and was able to swallow medications and water without any choking. (R1's) physician's report notes resident requires a renal diet.

The Administrator stated (R1) would sometimes cough when given a thin liquid and noticed this around 9/7/24; however, resident did not display any choking. The Administrator confirmed that resident is able to take all medications, without being crushed.

LPA observed (R1) that has multiple prescribed medications and those medications are being administered as ordered, as initialed on the Medication Administration Record (MAR).

Administrator stated one of the managers purchased some over-the-counter water thickener thinking there was not a prescription needed; however, the Administrator, who is a registered nurse, advised that a doctor's order will be needed to use a thickener for any resident.

The facility received an order for thickener on 9/18/24 and a physical copy was faxed to the facility today.

Resident was never given water thickener prior to an order and has not had any up to the writing of this report.

Based on information obtained, LPA finds the allegation 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. Copy of report provided to the Administrator.

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024

LIC9099 (FAS) - (06/04)

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