<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191290150
Report Date: 11/02/2022
Date Signed: 11/02/2022 12:51:48 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, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/04/2021 and conducted by Evaluator Nicholas Reed
COMPLAINT CONTROL NUMBER: 31-AS-20210604100503
FACILITY NAME:SUNRISE ADULT DEVELOPMENT CENTERFACILITY NUMBER:
191290150
ADMINISTRATOR:GLORIA ALLISONFACILITY TYPE:
775
ADDRESS:29890 BOUQUET CANYON ROADTELEPHONE:
(661) 296-8636
CITY:SAUGUSSTATE: CAZIP CODE:
91350
CAPACITY:49CENSUS: 0DATE:
11/02/2022
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Christine BratzelTIME COMPLETED:
12:59 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Client is causing harm to another client while in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
At approximately 10:30 a.m. on 11/02/2022 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced subsequent complaint visit. LPA met with the Administrator and disclosed the reason for the visit. Due to the COVID-19 pandemic, the facility has not reopened since closing on 03/13/2020.
From 11:15 a.m. to 12:45 p.m. LPA interviewed Administrator, Client #1 (C1), and Client #2 (C2). At 11:30 a.m. LPA conducted a records review.
Regarding the allegation above, it was alleged C2 hit and scratched C1 due to insufficient staff supervision. From interviews, the Administrator reported C1 had entered C2’s personal space. Without looking, C2 reached back and inadvertently pinched C1 on the arm. From record review, staff redirected C2 away from C1 and assessed C1 for injury. Staff also provided guidance to C1 about appropriate personal distancing and future social interactions. Based on interviews and record review, although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed UNSUBSTANIATED at this time.
Exit interview conducted. Copy of report provided. Appeal rights discussed.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 1