197608842-11-2-2022-11-AS-UCOL-CLQR9S-20221202115001

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608842
Report Date: 11/02/2022
Date Signed: 11/02/2022 04:08:29 PM

Unsubstantiated

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
10/24/2022 and conducted by Evaluator Don Senaha

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20221024154456

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: 70	DATE:	11/02/2022
		UNANNOUNCED	TIME BEGAN:	09:42 AM
MET WITH:	Steve Yong Jin Cho/Administrator		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Facility not providing transportation for resident's.
Facility not meeting resident's dietary needs.
Staff doesn't safeguard residents' property.

INVESTIGATION FINDINGS:

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On 11/02/2022 Licensing Program Analyst (LPA) Don Senaha initiated a complaint investigation for the allegations listed above. Today’s complaint investigation was conducted with Administrator Steve Yong Jin Cho.

The investigation consisted of the following: LPA requested resident roster, staff roster and other service documents. LPA interviewed Residents (R1-R7) and Staff (S1-S6). A plant inspection of the facility was conducted.

There were no deficiencies found during the visits.

Investigation revealed:

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Don Senaha	TELEPHONE: (323) 629-5133
LICENSING EVALUATOR SIGNATURE:	DATE: 11/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022

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-20221024154456

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: 11/02/2022

NARRATIVE

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Allegation: Facility not providing transportation for resident’s.
During the course of the investigation, LPA was unable to find any evidence supporting the allegation. LPA conducted interviews with residents (R1-R7). 7 of 7 residents stated there are no issues with transportation for residents. 4 of 7 residents have family members take them to their medical appointments. R1 has staff take them to medical appointments, R2 stated the doctor comes to the facility for medical appointments and R5 stated he takes the bus on his own to medical appointments. Resident (R1-R7) stated they do not go outside for any activities. 6 of 7 residents stated they do activities in-house so transportation is not needed. LPA conducted interviews with staff (S1-S6). Staff (S1-S4) stated family members provide transportation for the residents. Staff (S1, S3, S4) stated the primary care physician is in house and comes to the facility so residents do not need transportation. Staff (S1-S5) stated activities take place in house and according to the activities calendar. LPA obtained copy of the Admissions Agreement for 4 residents which states escort service for a doctor’s appointment or special outing will require a charge and has a minimum of 2 hours with a 1-week advance notice necessary. LPA observed and obtained activities calendar.

Based on the interviews conducted, observation and records review, LPA was unable to find evidence to support the allegation.

Allegation: Facility not meeting resident’s dietary needs.
During the course of the investigation, LPA was unable to find any evidence supporting the allegation. LPA conducted interviews with residents (R1-R7). 7 of 7 residents stated there are no concerns with the facility meeting resident’s dietary needs. R1 and R4 have dietary needs and have no issues with the food being served to meet their dietary needs. Residents (R2, R3, R5-R7) do not have any special diet but have no concerns with the food. 7 of 7 residents stated they do receive three (3) meals a day and snacks. 6 of 7 residents stated the menu does change. LPA conducted interviews with staff (S1-S6). 5 of 6 staff stated the facility does offer special dietary needs options for those residents who require special dietary needs. Staff (S1, S6) stated there is a weekly meeting to discuss the residents who require special dietary needs to ensure those needs are met. 6 of 6 staff stated the residents receive 3 meals per day and snacks. 6 of 6 staff stated the menu does change every day. LPA obtained the weekly menu. LPA obtained a copy of the written notes from the kitchen discussed in the weekly meetings for the special dietary needs of residents.

Based on the interviews conducted, observation and records review, LPA was unable to find evidence to support the allegation.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Don Senaha	TELEPHONE: (323) 629-5133
LICENSING EVALUATOR SIGNATURE:	DATE: 11/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20221024154456

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: 11/02/2022

NARRATIVE

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Allegation: Staff doesn’t safeguard residents’ property.

During the course of the investigation, LPA was unable to find any evidence supporting the allegation. LPA conducted interviews with residents (R1-R7). 7 of 7 residents stated there are no issues with anything stolen from their room. 7 of 7 residents stated they have no concerns with property not being safeguarded by staff. 7 of 7 residents feel safe here. LPA conducted interviews with staff (S1-S6). 5 of 6 staff stated there are no concerns from residents of property being stolen from a resident’s room. S1 stated we have CCTV which the facility uses as a safeguard in common areas should there be any issues.

LPA observed the CCTV cameras in the common areas of the facility. LPA obtained copy of the Admissions Agreement for 4 residents which addresses a section regarding “theft and loss policy” to be reviewed prior to resident move-in.

Based on the interviews conducted, observation and records review, LPA was unable to find evidence to support the allegation.

Based on the interviews conducted, observation and records review, LPA was unable to find evidence to support the allegations. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated.

An exit interview was conducted with Administrator Steve Yong Jin Cho and a hard copy was provided.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Don Senaha	TELEPHONE: (323) 629-5133
LICENSING EVALUATOR SIGNATURE:	DATE: 11/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022

LIC9099 (FAS) - (06/04)

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