197603807-8-24-2021-31-AS-NMAN-CMXS82-20230110123821

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603807
Report Date: 08/24/2021
Date Signed: 08/24/2021 03:15:52 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
06/30/2021 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20210630101236

FACILITY NAME:	SUNRISE AT STERLING CANYON		FACILITY NUMBER:	197603807
ADMINISTRATOR:	JOHNSON, MICHELLE M		FACILITY TYPE:	740
ADDRESS:	25815 MCBEAN PKWY		TELEPHONE:	(661) 253-3551
CITY:	VALENCIA	STATE: CA	ZIP CODE:	91355
CAPACITY:	140	CENSUS: 118	DATE:	08/24/2021
		UNANNOUNCED	TIME BEGAN:	08:56 AM
MET WITH:	Tammy Berry - Executive Director		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Residents are left in soiled diapers
Residents are not being provided medication

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegations. LPA met with Executive Director Tamara Berry and explained the reason for the visit,.

LPA conducted physical plant tour at 9:55 PM. Requested facility documents relevant to the investigation at 10:30 AM and conducted interview with residents and staff between 10:30 AM to 2:30 PM. Regarding the allegation that Residents are left in soiled diapers, LPA's with the Executive Director on 07/01/21 at 1:50 PM, Assisted Living (AL) Coordinator today at 1:41 PM today and three (3) lead care staff both AL and Memory Care (MC) units, revealed that there was no report of any resident who was left in soiled diapers in either AL or MC units. LPA's interview with three (3) care staff confirmed that they did not have nor witness any resident who was left in soiled diapers.

(continued on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021

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 31-AS-20210630101236

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: SUNRISE AT STERLING CANYON	FACILITY NUMBER: 197603807
	VISIT DATE: 08/24/2021

NARRATIVE

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(continued from LIC 9099)

Regarding the allegation that Residents are not being provided medication, LPA interview with the Resident Care Director on 07/01/21 at 10:00 and today at 11:00 AM, revealed that she did not receive any report that a resident missed or not being provided a medication. She admitted however, that there was some delay in some cases but there was no resident missed any medication. LPA's interview with three (3) medication technician on 07/01/21 between 10:45 AM to 2:00 PM, confirmed that they did not miss any medication to any resident but delays from the allowed medication time frame were inevitable but on a very limited basis. LPA's interview with eight (8) residents also revealed that they always have their medication regularly and on time.

Based on the information gathered during this and prior visit, the allegations are deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021

LIC9099 (FAS) - (06/04)

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