197608842-9-11-2025-11-AS-SCIS-DN75RT-20251106191137

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608842
Report Date: 09/11/2025
Date Signed: 09/11/2025 03:50:25 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/21/2025 and conducted by Evaluator Elvira Gonzalez

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20250721104317

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; 120	CENSUS: 68	DATE:	09/11/2025
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Steve Cho		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility staff do not ensure resident is provided adequite supervision resulting in resident having multiple falls while in care.

INVESTIGATION FINDINGS:

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On 09/11/25, Licensing Program Analyst (LPA) Elvira Gonzalez conducted a subsequent unannounced complaint visit to further investigate the allegations mentioned above. LPA met with Administrator, Steve Cho, and the purpose of the visit was explained. LPA was granted entrance to the facility.

The investigation consisted of the following: On 07/28/25, LPA requested the staff and resident rosters. LPA reviewed service records for resident #1 (R1) and requested copies of the following documents: Facesheet, Physician’s Report, Service and Care Plan, Resident notes (dated 07/14/25-07/19/25), Unusual Incident/Injury Report (dated: 07/21/25), and 2-Hour Rounds Check Policy Form. Additionally, LPA conducted interviews with staff #1-#5 (S1-S5), witness #1 (W1), attempted to interview witness #2 (W2), residents #2-#4 (R2-R4) and attempted to interview R1. On 09/11/25, LPA Gonzalez conducted interviews with residents #5-#6 (R5-R6), and S1.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025

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-20250721104317

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: SUNNY HILLS ASSISTED LIVING (MEMORY CARE)	FACILITY NUMBER: 197608842
	VISIT DATE: 09/11/2025

NARRATIVE

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The investigation revealed the following:

Allegation: Facility staff do not ensure resident is provided adequate supervision resulting in resident having multiple falls while in care. It is being alleged that a resident has sustained multiple falls at the facility resulting in resident having multiple bruises on their arms, and face. On 07/28/25, between 10:20 AM and 12:00 PM, LPA conducted interviews with S1-S5. Of those interviewed, 5 out of 5 staff stated that they provide adequate supervision for residents to prevent any fall and/or injuries. 3 out of 5 staff said they did not know if R1 fell on 07/19/25, and 2 out of 5 staff stated R1 did fall. 3 out of 5 staff stated that R1 does not fall frequently. 5 out of 5 staff stated that residents are checked on every 2 hours and as needed.

On 07/28/25, between 1:05 PM and 2:00 PM, LPA conducted interviews with R2-R4 and attempted to interview R1 but was unable to as R1 is in the hospital. On 09/11/25, between 1:00 PM and 1:45 PM, LPA conducted interviews with R5-R6. Of those interviewed, 5 out of 5 residents said they weren’t aware of a resident sustaining multiple falls. 5 out of 5 residents reported feeling safe when being assisted by staff. 5 out of 5 residents said they are satisfied with staff and the services provided to them.
On 09/11/25, LPA conducted a review of records and revealed the following: Physician’s Report (dated: 07/09/25) noted that resident is non-ambulatory and will participate in unsafe wandering and will try and get out of bed without reason and/or physical power. An Unusual Incident/Injury Report (dated: 07/21/25) reported that on 07/19/25, at around 05:30 AM, R1 was found on the floor with a laceration on left eye area. R1 was assessed, and first aid was provided. R1’s responsible party was then notified, and staff continued to observe R1 for any change in condition. Then at 08:10 AM, R1 was observed bleeding from nose, and 911 was called and resident was transported to hospital.

Based on observation, records reviewed, and interviews conducted, the department did not find sufficient evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation, did or did not occur, therefore the allegation is unsubstantiated.

An exit interview was conducted, and a copy of the report along with appeal rights was provided to Administrator, Steve Cho.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/21/2025 and conducted by Evaluator Elvira Gonzalez

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20250721104317

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; 120	CENSUS: 68	DATE:	09/11/2025
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Steve Cho		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff does not ensure resident receives sufficient continence care resulting in resident being left in multiple soaked diapers.

INVESTIGATION FINDINGS:

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Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025

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 5

Control Number 11-AS-20250721104317

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: SUNNY HILLS ASSISTED LIVING (MEMORY CARE)	FACILITY NUMBER: 197608842
	VISIT DATE: 09/11/2025

NARRATIVE

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The investigation revealed the following:

Allegation: Staff does not ensure resident receives sufficient continence care resulting in resident being left in multiple soaked diapers. It is being alleged that a resident came into the emergency department wearing 3 diapers that were all soaked through. On 07/28/25, between 10:20 AM and 12:00 PM, LPA conducted interviews with S1-S5. Of those interviewed, 5 out of 5 staff stated that they did not know if the above allegation happened. 5 out of 5 staff said they do not put more than one diaper on a resident. Interview conducted with S1 revealed that after conducting their own investigation, they became aware of two staff admitting to putting more than one diaper on a resident, and that they have taken the necessary disciplinary action.

On 07/28/25, between 1:05 PM and 2:00 PM, LPA conducted interviews with R2-R4 and attempted to interview R1 but was unable to as R1 is in the hospital. On 09/11/25, between 1:00 PM and 1:45 PM, LPA conducted interviews with R5-R6. Of those interviewed, 5 out of 5 residents said they weren’t aware of a resident sustaining multiple falls. 5 out of 5 residents reported feeling safe when being assisted by staff. 5 out of 5 residents said they are satisfied with staff and the services provided to them.

Based on record reviewed, and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be substantiated. Title 22, Division 6 Chapter 8 are being cited on the attached LIC 9099D.

An exit interview was conducted, and a copy of the report along with appeal rights was provided to Administrator, Steve Cho.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 11-AS-20250721104317

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: SUNNY HILLS ASSISTED LIVING (MEMORY CARE)	FACILITY NUMBER: 197608842
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/11/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/18/2025 Section Cited CCR 87468.1	1 2 3 4 5 6 7	87468.1 Personal Rights of Residents in All Facilities. (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This regulation is not met as evidenced by:	1 2 3 4 5 6 7	Administrator will provide an in service training for all staff on personal rights for the residents. Administrator agreed to submit in service training log to LPA Gonzalez via email by POC due date.
	8 9 10 11 12 13 14	Based on interview with S1 revealed that two staff members admitted to putting multiple diapers on a resident which poses a potential health and safety risk to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025

LIC9099 (FAS) - (06/04)

Page: 5 of 5