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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197605842
Report Date: 10/10/2023
Date Signed: 10/12/2023 07:47:07 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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
01/14/2021 and conducted by Evaluator Melissa Spaeth
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20210114161003
FACILITY NAME:SUNFLOWER PLACE RCFE CORPFACILITY NUMBER:
197605842
ADMINISTRATOR:DORIS KLEINFACILITY TYPE:
740
ADDRESS:10022 E. AVENUE Q14TELEPHONE:
(661) 733-9258
CITY:LITTLEROCKSTATE: CAZIP CODE:
93543
CAPACITY:0CENSUS: 0DATE:
10/10/2023
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Doris KleinTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Facility is in disrepair, boards on windows
Licensee did not properly store food
Facility is not kept clean
Facility does not have individual towels in the bathroom
INVESTIGATION FINDINGS:
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This is an amended copy of the report previously issued on 08/11/2021 and 01/21/2021. This report supersedes report previously issued. The findings for this complaint remain the same.

Licensing Program Analyst (LPA) Melissa Spaeth conducted an unannounced subsequent complaint investigation for the allegations listed above. LPA Spaeth explained to Doris Klein the purpose of the visit. A physical plant walk through was completed.

Regarding the allegation: Facility is in disrepair, boards on windows. It’s being alleged that boards are installed within the window around the swamp coolers. During LPA Spaeth’s visit on 01/21/2021, LPA observed plywood was covering part of the opened window and the air conditioner was supported by wood planks. LPA observed the air conditioners in both rooms were securely positioned by the wood planks to ensure the units would not fall out of the windows.
Cont'd on 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2023
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 4
Control Number 31-AS-20210114161003
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: SUNFLOWER PLACE RCFE CORP
FACILITY NUMBER: 197605842
VISIT DATE: 10/10/2023
NARRATIVE
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Regarding the allegation: Licensee did not properly store food. It’s being alleged that cheese, and a can of sauce, were not properly stored in the refrigerator. During LPAs visit on 01/21/2021, LPA observed all food stored within the refrigerator were covered and the bread sitting on the counter was covered.

Regarding the allegation: Facility is not kept clean. It’s being alleged that kitchen was cluttered with various items on the kitchen counters, the kitchen was not clean, and the kitchen trash can was full. During LPAs visit on 01/21/2021, LPA observed the kitchen as clean. There was no clutter on the counters and the kitchen trash can was empty.

Regarding the allegation: Facility does not have individual towels in the bathroom. It’s being alleged hand towels were not provided for the residents. During LPAs visit on 01/21/2021, LPA observed paper towels were located in the bathrooms. The Administrator stated since COVID-19, residents are using paper towels.

Based on LPA’s observations and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation(s) may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are unsubstantiated.



Exit interview was conducted, and a copy of the report was given.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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
01/14/2021 and conducted by Evaluator Melissa Spaeth
COMPLAINT CONTROL NUMBER: 31-AS-20210114161003

FACILITY NAME:SUNFLOWER PLACE RCFE CORPFACILITY NUMBER:
197605842
ADMINISTRATOR:DORIS KLEINFACILITY TYPE:
740
ADDRESS:10022 E. AVENUE Q14TELEPHONE:
(661) 733-9258
CITY:LITTLEROCKSTATE: CAZIP CODE:
93543
CAPACITY:0CENSUS: 0DATE:
10/10/2023
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Doris KleinTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Licensee did not make hazardous items inaccessible to residents.
INVESTIGATION FINDINGS:
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This is an amended copy of the report previously issued on 08/11/2021 and 01/21/2021. This report supersedes report previously issued. The findings for this complaint have been updated.

Regarding the allegation: Licensee did not make hazardous items inaccessible to residents. It’s being alleged that cleansers, bug spray, sharp tools, scissors, and nails are laying around in the kitchen and dining room. During LPA’s 1/21/2021 visit, LPA observed a Lysol cleaning bottle on top of the toilet and a bottle of bleach in the bathroom. Administrator stated a storage cabinet was located outside the kitchen door. LPA observed the Administrator placed the cleaning solutions in the storage cabinet and locked the cabinet.

Based on LPA’s observations and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be Substantiated. California Code of Regulations, Title 22 Division (6) and Chapter (8) are being cited on the attached LIC9099-D.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 31-AS-20210114161003
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: SUNFLOWER PLACE RCFE CORP
FACILITY NUMBER: 197605842
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/10/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/04/2023
Section Cited
CCR
80087(g)
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80087 Building & Grounds (g) Disinfectants, cleaning solutions, poisons,….that could pose a danger if readily available to clients shall be stored where inaccessible to clients. This is evidence by:
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During LPA's visit, LPA observed the Administrator locked the cleaning solutions in an outdoor cabinet.
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LPA Spaeth observed Lysol cleaning bottle on top of the toilet and a bottle of bleach in the bathroom, which poses an immediate health, safety, or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4