Inspection visit

complaintApril 29, 2021

SUNRISE VALLEY INC - KAMANALicense 3618806613 citations on this visit

3 citations recorded

Inspector’s narrative

What the inspector wrote

The above allegation of Facility staff neglect resident resulting in bruises, is SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. Allegation #2 Facility staff failed to contact resident's family after incident resulting in injury (bruising). Based on observation, Documentation, interviews and record review, LPA was able to corroborate the allegation. There was not any documentation provided to support the facility had notified R1's responsible party about the incident that occurred in November 2019. There was nothing noted in R1s log that the responsible party was notified. Additionally, the facility did not submit an LIC624 noting that the incident had occurred. The above allegation(s) of Facility staff failed to contact resident's family after incident resulting in injury (bruising) is SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. Allegation #3 Facility staff failed to seek timely medical care for residents . Based on observation, interviews, documentation and record review the facility staff did not seek medical attention for the incident that occurred on 11/11/19 where R1 sustained bruising. There was not an LIC 624 submitted to the department regarding the injury resulting in bruising. There was also no documentation in R1s log of having been sent out or facility staff informing the home health agency about the bruising, and if any additional medical attention would be necessary. The allegation of Facility staff failed to seek timely medical care for residents is SUBSTANTIATED . A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. Based on the investigation deficiencies were observed according to California Code of Regulations, (Title 22, Division 6, Chapter will be cited and on the attached LIC9099D An exit interview was conducted and a copy of this report, 9099D, and appeal rights were provided to Licensee Khristine Smith and Administrator Abigail Tamasin.

Citations

4 citations recorded^*CCLD

What does Type A vs Type B mean?

Type A. Serious citation. Imminent or substantial risk to children. The regulator requires corrective action immediately and may impose a civil penalty.

Type B. Lower-severity citation. Corrective action required, no imminent risk. The regulator monitors compliance on the next visit.

80065(f)(3)Type B
80065 Personnel requirements(f) All personnel shall be given on-the-job training or shall have related experience which provides knowledge of and skill in the following areas, as appropriate to the job assigned and as evidenced by safe and effective job performance.(3) Provision of client care and supervision, including communication. This requirement was not met as evidenced by: Based on observation, interview and record review the licensee did not ensure that there was communication in regards to the resident and obtaining the bruises. This poses a potential Health, Safety or Personal Rights risk to persons in care.
80075(a)Type B
80075 Health Related Services(a) The licensee shall ensure that each client receives necessary first aid and other needed medical or dental services, including arrangement for and/or provision of transportation to the nearest available services. This requirement was not met as evidenced by: Based on observation, interview and record review the licensee did not ensure R1 was given medical attention after obtaining bruises on one occasion. This poses a potential Health, Safety or Personal Rights risk to persons in care.
87211(a)(1)Type B
87211 Reporting requirements(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following:(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. This requirement was not met as evidenced by: Based on observation, interview and record review the licensee did not report the bruises at least 1 time. This poses a potential Health, Safety or Personal Rights risk to persons in care.
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87464(a)(4)Type B
87464 Basic Services(a)The services provided by the facility shall be conducted so as to continue and promote, to the extent possible, independence and self-direction for all persons accepted for care. Such persons shall be encouraged to participate as fully as their conditions permit in daily living activities both in the facility and in the community.(4)Personal assistance and care as needed by the resident and as indicated in the pre-admission appraisal, with those activities of daily living such as dressing, eating, bathing and assistance with taking prescribed medications… This requirement is not met as evidenced by: Based on observation, interviews, and record review, the licensee did not ensure that basic services were provided to at least 1 out of 6 residents for 6 out of 6 days. This poses a potential Health, Safety, or Personal Rights risk to persons in care.
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FAQ · About this visit

Common questions about this visit

What happened during the April 29, 2021 inspection of SUNRISE VALLEY INC - KAMANA?

This was a complaint inspection of SUNRISE VALLEY INC - KAMANA on April 29, 2021. 3 citations were issued: 3 Type B.

Were any citations issued to SUNRISE VALLEY INC - KAMANA on April 29, 2021?

Yes, 3 citations were issued (0 Type A, 3 Type B). The first citation was for: "80065 Personnel requirements(f) All personnel shall be given on-the-job training or shall have related experience which ..."

What type of inspection was this?

This was a complaint inspection. Complaint inspections are triggered when someone reports a concern about the facility to CCLD.

SourceView on CCLD View original report

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Data from CCLD public records. Last updated May 25, 2026. If you believe any information is inaccurate, report it here.

complaint·April 29, 2021