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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200726
Report Date: 07/18/2022
Date Signed: 07/18/2022 03:45:53 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
07/13/2022 and conducted by Evaluator Leslie Ibo
COMPLAINT CONTROL NUMBER: 15-AS-20220713130728
FACILITY NAME:SUNRISE CARE HOME IIFACILITY NUMBER:
019200726
ADMINISTRATOR:TAYAG, NANCY RFACILITY TYPE:
740
ADDRESS:1435 VIA LUCASTELEPHONE:
(510) 398-8677
CITY:SAN LORENZOSTATE: CAZIP CODE:
94580
CAPACITY:6CENSUS: 6DATE:
07/18/2022
UNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Nancy Tayag, Administrator TIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff financially exploited a resident
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 7/18/2022 at 10:50AM, Licensing Program Analyst (LPA) L. Ibo arrived unannounced to investigate the above allegation. LPA met with Administrator Nancy Tayag and informed her the purpose of the visit.

During the course of investigation, based on LPA’s interview and records review, R1 is alert and oriented, R1 admitted that she owes money to S1.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is unsubstantiated. Exit Interview conducted and a copy of this report provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Leslie IboTELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2022
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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