197608842-6-26-2024-11-AS-JHAD-D7AM4H-20240718091645

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608842
Report Date: 06/26/2024
Date Signed: 06/26/2024 02:07:11 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
06/19/2024 and conducted by Evaluator Perry Scott

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20240619150645

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: 87	DATE:	06/26/2024
		UNANNOUNCED	TIME BEGAN:	09:41 AM
MET WITH:	Steve Cho		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff did not ensure that the resident's call assistance button was operable.
Staff did not assist resident in a timely manner.

INVESTIGATION FINDINGS:

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On 06/26/24, at 09:30am, Licensing Program Analyst (LPA) Perry Scott conducted a 10-day complaint visit to the facility and was greeted by Steve Cho, Administrator. LPA explained the purpose of this visit is to gather information about the complaint and deliver findings for the allegations mentioned above.

The investigation consisted of the following: LPA investigated the allegations mentioned in this complaint; and conducted interviews with staff (S1-S4) and residents (R1-R8). Resident Roster (Dated 06/19/24), Staff Roster (Dated 06/26/24), ID/Emergency Information (Dated 04/31/24), and Admission Agreement (Dated 04/31/24/Unsigned) for R1 were obtained from the facility.

The investigation revealed the following: Allegation #1- Staff did not ensure that the resident's call assistance button was operable.

Report continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Perry Scott	TELEPHONE: (707) 849-2315
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024

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-20240619150645

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: 06/26/2024

NARRATIVE

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The details of the complaint alleged that R1’s call button was faulty and R1 yelled for assistance for hours, but no one came. On 06/26/24, from 10:00am-2:00pm, LPA interviewed staff (S1-S4) and residents (R1-R8) regarding the allegation. R1 could not be interviewed because R1 is no longer at the facility and no new contact information was given. 4 of 4 staff denied the allegation that the Staff did not ensure that the resident's call assistance button was operable. All staff (S1-S4) stated that each room and bathroom have a working call button that alerts the front desk when pushed. Additionally, when the button is pushed, a caregiver is paged to go and check on the resident. The staff stated they have no knowledge of anyone complaining that they were not assisted when the call button was pushed. S1 further stated that S1 had no knowledge of R1 calling for assistance and not receiving it.

LPA toured the facility and checked two downstairs rooms (Room 102 and 103) and three upstairs rooms (Room 201, 202, and 206) and found the call buttons all worked and that they registered at the front desk computer. LPA noticed that it took the staff less than five minutes to respond to the call alert. LPA interviewed R1-R8 about the allegation and 7 of 8 residents that were interviewed denied the allegation that Staff did not ensure that the resident's call assistance button was operable. All residents interviewed stated that their call button works and when they need assistance and push the button for help, they are given the assistance they need.

Based on interviews, there is insufficient evidence to support the allegation that the Staff did not ensure that the resident's call assistance button was operable. 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.

Allegation #2- Staff did not assist resident in a timely manner.

The details of the complaint alleged that R1 fell on the floor in the middle of the night, called for help, and no one assisted R1 until hours later. 06/26/24, from 10:00am-2:00pm, LPA interviewed staff (S1-S4) and residents (R1-R8) regarding the allegation. R1 could not be interviewed because R1 is no longer at the facility and no new contact information was given. 4 of 4 staff denied the allegation that the Staff did not assist resident in a timely manner. All staff (S1-S4) stated that all residents are assisted in a timely manner and had no knowledge of R1 falling. S1 stated that there is no record of R1 falling, and R1 did not fall to S1s knowledge.

Report continued on LIC9099-C

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Perry Scott	TELEPHONE: (707) 849-2315
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20240619150645

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: 06/26/2024

NARRATIVE

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LPA interviewed R1-R8 about the allegation and 7 of 8 residents that were interviewed denied the allegation that Staff did not assist resident in a timely manner. All residents interviewed stated that they have not had any problems with getting assistance in a timely manner from the staff when they need help.

Based on interviews, there is insufficient evidence to support the allegation that the Staff did not assist resident in a timely manner. 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.

No deficiencies were cited.

An exit interview was conducted with Steve Cho, Administrator, and a hard copy of this report was provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Perry Scott	TELEPHONE: (707) 849-2315
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024

LIC9099 (FAS) - (06/04)

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