345920097-9-26-2024-59-AS-KHOS-D9LKMJ-20240930080136

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 345920097
Report Date: 09/26/2024
Date Signed: 09/26/2024 05:18:07 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
09/26/2024 and conducted by Evaluator Sabrina Calzada

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20240926113040

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:	02:35 PM
MET WITH:	Blessing Ugbo, Administrator		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff modified resident’s medication without 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 9/26/24. 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, to investigate another allegation.

LPA reviewed paperwork from resident (R1's) file, text messages between multiple facility and contacted another manager by phone during today's inspection. The results of the investigation are as follows:

The allegation states that staff (S1) reported to a third party that resident (R1) has been refusing to take their medications and so the same staff crushed (R1's) medications without a physician's order. The allegation states (R1) still refused the crushed medications.

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-20240926113040

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 and the physician's report shows that (R1) has a history of refusing medications prior to being admitted to the facility. Documentation shows resident takes approximately (8) medications and resident will pick and choose which medications they want to take.

LPA was provided with text messages from the Administrator showing multiple facility staff discussing this concern brought to their attention about staff crushing medications. Both the text messages and conversation with the Administrator and another manager, Linda, show that no staff have been instructed to crush medications for any resident, unless there is a physician's order. Linda clarified with (S1) that she was asked to crush (R1's) medications by a placement agency representative, and (S1) indicated she absolutely cannot crush any medications for any resident without a doctor's order.

LPA reviewed hospital discharge paperwork showing (R1) was sent to the Emergency room on 9/25/24 for Dysphagia. Resident returned around 1:00 am the next day, and with an order for crushed medications. The facility can now offer medications crushed. Resident has one medication that is a capsule and cannot be crushed, but it can be opened and mixed with applesauce.

Administrator stated that (R1) has not received any crushed medications as of 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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