019200726-6-7-2022-15-AS-KHOS-CG2N2Q-20220705100507

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200726
Report Date: 05/06/2022
Date Signed: 06/07/2022 01:09:12 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/06/2022 and conducted by Evaluator Gregory Clark

COMPLAINT CONTROL NUMBER: 15-AS-20220506135724

FACILITY NAME:	SUNRISE CARE HOME II		FACILITY NUMBER:	019200726
ADMINISTRATOR:	TAYAG, NANCY R		FACILITY TYPE:	740
ADDRESS:	1435 VIA LUCAS		TELEPHONE:	(510) 398-8677
CITY:	SAN LORENZO	STATE: CA	ZIP CODE:	94580
CAPACITY:	6	CENSUS:	DATE:	05/06/2022
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Nancy Tayag, Administrator		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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9

Illegal Eviction

INVESTIGATION FINDINGS:

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13

***This is an amended report from the report issued on 5/06/21***
On 6/07/22 at 1:05 p.m. Licensing Program Analyst (LPA) G. Clark arrived unannounced to deliver this amended report. LPA met with Nancy Tayag, Administrator.

During the course of investigation, LPA interviewed, client #1 (C1), complainant, facility administrator and 2 staff. C1's records including admission agreement were reviewed.

Based on interviews conducted C1 currently has no financial means to pay for her placement at the facility. C1's family told facility administrator to take C1 to the ER and leave her there so the county would have to find placement. Facility Administrator reported to LPA that she had no intention of taking C1 to the ER and will issue a proper 30 notice to C1 for non-payment of monthly board and care. LPA advised Administrator of the proper components of an eviction notice.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Yvonne Flores-Larios	TELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Gregory Clark	TELEPHONE: 510-285-3927
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2022

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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