197608842-5-26-2023-11-AS-JHAD-D5K2A8-20240523171305

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608842
Report Date: 05/26/2023
Date Signed: 05/26/2023 03:16:09 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/10/2022 and conducted by Evaluator Mario Leon

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20221010123746

FACILITY NAME:	SUNNY HILLS ASSISTED LIVING (MEMORY CARE)		FACILITY NUMBER:	197608842
ADMINISTRATOR:	SUNGNAM PARK "SUSAN"		FACILITY TYPE:	740
ADDRESS:	8717 WEST OLYMPIC BLVD.		TELEPHONE:	(310) 659-4301
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90035
CAPACITY:	120	CENSUS: 85	DATE:	05/26/2023
		UNANNOUNCED	TIME BEGAN:	08:02 AM
MET WITH:	Steve Cho, Administrator		TIME COMPLETED:	04:03 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility has insects.
Facility has rats.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing program Analysts (LPAs) Antonia Alvizar, Mario Leon, Wendy Gibbs and Licensing Program Managers (LPMs) Naira Margaryan and Ulysses Coronel conducted an unannounced subsequent complaint visit to the facility. LPAs and LPMs met the Administrator, Steve Cho, who was informed that this visit was conducted to continue an investigation of the complaint allegations, previously initiated on 10/19/2022.

The investigation consisted of: On10/19/2022 LPA Alvizar requested resident, staff and facility records and interviewed staffs S1-S3. LPAs Don Senaha and Gibbs interviewed witness, staff and residents. On 5/26/2023 LPA Leon and LPM Coronel reviewed facility records, interviewed seven (7) residents and six (6) staff and inspected eight (8) resident bedrooms, the laundry room, emergency food storage and kitchen.

Report continues, see LIC9099C.

Substantiated

Estimated Days of Completion: 90

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Mario Leon	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 05/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023

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 5

Control Number 11-AS-20221010123746

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: SUNNY HILLS ASSISTED LIVING (MEMORY CARE)	FACILITY NUMBER: 197608842
	VISIT DATE: 05/26/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

The investigation revealed the following:

Regarding the allegation: "Facility has rats" On 10/19/22 approximately at 10:30am, LPAs and LPM inspected the facility laundry room. LPA and LPM observed fresh black rodent droppings and rat traps located in the laundry room located in the parking garage of the facility. Based on interview, observation, there is a sufficient information to verify the allegation. Therefore, the allegation is Substantiated.

Regarding the allegation: “Facility has insects” On 10/19/22 approximately at 10:59am, LPAs Leon and Senaha and LPM Coronel inspected bedroom number 106. LPAs and LPM observed live dark brown insects scurrying to the darkness under the bed nearest the door. LPA Leon observed dead cockroaches which are about 2cm in size near the closet doors. Based on interviews and observations, there is a sufficient information to verify the allegation. Therefore, the allegation is Substantiated.

An exit interview was conducted and plans of corrections were developed. Title 22 regulations are being cited, see LIC9099D. A copy of this report and appeals rights were provided to Administrator, Steve Cho.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Mario Leon	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 05/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 11-AS-20221010123746

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: SUNNY HILLS ASSISTED LIVING (MEMORY CARE)	FACILITY NUMBER: 197608842
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/26/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/26/2023 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	Maintenance and Operation. The facility shall be clean, safe, sanitary and in good repair...Maintenance shall include...maintenance services and procedures...of residents, employees and visitors. This requirement was not met at evidenced by:	1 2 3 4 5 6 7	During today's visit, LPA and LPM did not observe any evidence of rat presence at the facility and the Administrator provided proof that the facility has contracted with an exterminator company to service the facility on a monthly basis. No proof of correction needed.
	8 9 10 11 12 13 14	Based on observations and interviews conducted, the licensee failed to ensure that the facility was clean, safe and sanitary on 10/19/2022. LPA observed evidence of rats presence at facility which poses a potential health, safety and personal rights risk to residents in care.	8 9 10 11 12 13 14
Type B 05/26/2023 Section Cited CCR 87307(d)(2)	1 2 3 4 5 6 7	Personal Accommodations and Services. The following space and safety provisions shall apply to all facilities: The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	During today's visit, LPA and LPM did not observe any evidence of insect presence in resident bedrooms, kitchen and laundry area. The Administrator provided proof that the facility has contracted with an exterminator company to service the facility on a monthly basis.
	8 9 10 11 12 13 14	Based on observations and interviews conducted, the licensee failed to provide a safe and healthful environment, on 10/19/2022 LPA and LPM observed evidence of cockroaches in resident bedrooms which poses a potential health, safety and personal rights risk to residents in care.	8 9 10 11 12 13 14	No proof of correction needed.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Mario Leon	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 05/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/10/2022 and conducted by Evaluator Mario Leon

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20221010123746

FACILITY NAME:	SUNNY HILLS ASSISTED LIVING (MEMORY CARE)		FACILITY NUMBER:	197608842
ADMINISTRATOR:	SUNGNAM PARK "SUSAN"		FACILITY TYPE:	740
ADDRESS:	8717 WEST OLYMPIC BLVD.		TELEPHONE:	(310) 659-4301
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90035
CAPACITY:	120	CENSUS: 85	DATE:	05/26/2023
		UNANNOUNCED	TIME BEGAN:	08:02 AM
MET WITH:	Steve Cho, Administrator		TIME COMPLETED:	04:03 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff not responding to resident's call button.
Resident's rooms are not cleaned.
Staff restraining resident's.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing program Analysts (LPAs) Antonia Alvizar, Mario Leon , Wendy Gibbs and Licensing Program Managers (LPMs) Naira Margaryan and Ulysses Coronel conducted an unannounced subsequent complaint visit to the facility. LPAs and LPMs met the Administrator, Steve Cho, who was informed that this visit was conducted to continue an investigation of the complaint allegations, previously initiated on 10/19/2022.

The investigation consisted of: On10/19/2022 LPA Alvizar requested resident, staff and facility records and interviewed staffs S1-S3. LPAs Don Senaha and Gibbs interviewed witness, staff and residents. On 5/26/2023 LPA Leon and LPM Coronel reviewed facility records, interviewed seven (7) residents and six (6) staff and inspected eight (8) resident bedrooms, the laundry room, emergency food storage and kitchen.

Report continues, see LIC9099C.

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Mario Leon	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 05/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 11-AS-20221010123746

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: SUNNY HILLS ASSISTED LIVING (MEMORY CARE)	FACILITY NUMBER: 197608842
	VISIT DATE: 05/26/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

The investigation revealed the following:

Regarding the allegation "Staff are not responding to the Call button". During today's visit, staff responded at an average of four (4) minutes to six (6) out of eight (8) call buttons tested by LPA Leon and LPM Coronel. Six (6) out of six (6) residents did not have any concern with the allegation listed above. In addition S1-S4 corroborated that staff conduct resident bedroom checks every thirty (30) minutes to two (2) hours.
Regarding the allegation "Staff are not responding to the Call button"; based on interviews, inspection and observation, there is insufficient information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED.

Regarding the allegation "resident rooms are not cleaned". During today's visit LPA Leon and LPM Coronel inspected eight (8) resident rooms and found that all eight (8) bedrooms were found to be in clean and sanitary condition. Six (6) out of six (6) residents did not have any concern with the allegation listed above. Per staff interviews, housekeeping cleans resident bedrooms on a weekly basis and caregivers clean resident bedrooms while providing care to residents. Regarding the allegation "resident rooms are not cleaned"; based on interviews, inspection and observation, there is insufficient information to verify the allegation listed above. Therefore, the allegation is UNSUBSTANTIATED.

Regarding the allegation "Staff restraining resident's.". During today's visit LPA Leon and LPM Coronel did not observe any form of restraints being applied towards residents in care. Per staff interviews, five (5) out of six (6) staff deny the allegation above. In addition, all six (6) residents denied the allegation above. Regarding the allegation "Staff restraining resident's."; based on interviews, inspection and observation, there is insufficient information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED.

There are no deficiencies being sited for the above allegations. An exit interview was conducted and a copy of this report was provided to Administrator, Steve Cho.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Mario Leon	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 05/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023

LIC9099 (FAS) - (06/04)

Page: 5 of 5