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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608842
Report Date: 10/27/2025
Date Signed: 10/27/2025 02:24:04 PM

Substantiated


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 ANGELESSTATE: CAZIP CODE:
90035
CAPACITY:120; 120CENSUS: 67DATE:
10/27/2025
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Chansook KooTIME COMPLETED:
02:35 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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On 10/27/25, Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced subsequent complaint visit to deliver amended report for the allegation mentioned above. LPA met with Chansook Koo, Receptionist, and the purpose of the visit was explained. LPA was granted entrance to the facility. ** **This report supersedes the report created and delivered on 09/11/25. This report is to clarify findings.

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.

Continued on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2025
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 3
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: 10/27/2025
NARRATIVE
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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.
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 don’t use diapers. 5 out of 5 residents said they don’t know if staff puts multiple diapers on any resident.

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 LIC9099-D.

An exit interview was conducted, and a copy of the report along with appeal rights was provided to Chansook Koo.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
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: 10/27/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/18/2025
Section Cited
CCR
87468.1(a)(2)
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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:
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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 09/18/25.
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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.

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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: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2025
LIC9099 (FAS) - (06/04)
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