197607950-3-25-2022-31-AS-CHAS-CD9UBR-20220407152645

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607950
Report Date: 03/25/2022
Date Signed: 03/25/2022 01:31:55 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
03/25/2022 and conducted by Evaluator Tuesday Cabiness

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20220325084713

FACILITY NAME:	SUNLAND MANOR INC.		FACILITY NUMBER:	197607950
ADMINISTRATOR:	ARYEH ROSNER		FACILITY TYPE:	735
ADDRESS:	10540 SHERMAN GROVE AVE		TELEPHONE:	(818) 352-5941
CITY:	SUNLAND	STATE: CA	ZIP CODE:	91040
CAPACITY:	98	CENSUS: 92	DATE:	03/25/2022
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Areyeh Rosner		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Staff did not attempt to locate resident after an extended period of time away from the facility

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tuesday Cabiness conducted a complaint investigation and met with the Administrator Areyeh Rosner, and informed him the reason of the visit.

From 1230pm to 145pm, LPA conducted interviews with the Administrator and resident # 1 (R1), as well reviewed facility and resident records. On 03/22/2022, LPA reviewed an special incident report (SIR) that was sent to Licensing regarding R1 leaving the facility, and did not return. The report also revealed that R1 was assaulted and robbed by unknown individuals, and someone contacted 911. R1 was treated at the hospital. The Administrator reported to LPA that R1 and other residents are allowed to the leave the facility unassisted, and can come and go as they please. R1 has a history of leaving, and always returns within (2) days. Therefore, based information obtained from the Administrator and R1, the allegation is UNSUBSTANTIATED at this time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2022

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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