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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608842
Report Date: 11/08/2022
Date Signed: 11/08/2022 04:00:30 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
10/31/2022 and conducted by Evaluator Jeremiah Randle
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20221031142345
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:120CENSUS: 71DATE:
11/08/2022
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator Woohyun ParkTIME COMPLETED:
04:20 PM
ALLEGATION(S):
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Staff do not ensure the residents are being properly fed while in care

Residents are not consuming an appropriate amount of water while in care
INVESTIGATION FINDINGS:
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On 11/08/2022 at 9:30a.m. Licensing Program Analyst (LPA) Jeremiah Randle conducted an unannounced visit to deliver the findings of the complaint with the above allegations. LPA identified himself and discussed the purpose of the visit and the elements of the allegation with Administrator Woohyun Park

The investigation consisted of the following:

On 11/08/2022 LPA conducted observation of physical plant during breakfast and lunch hour, conducted Staff Interviews (S1-S4), and Resident interviews R1-R7, reviewed facility Files for Administrator and residents R1-R7 , LPA obtained copies of pertinent documents pertaining to the allegations. LPA requested from the facility administrator (Admissions Agreement, House Rules, Physicians Reports /Medical Records, Client Roster, Staff Roster) Needs and Services, Functional Capability Assessment, SIR’s/SOC 341, staff / nursing notes facility menus and other documents relevant to the investigation.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Jeremiah RandleTELEPHONE: (323) 213-1116
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2022
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 4
Control Number 11-AS-20221031142345
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: 11/08/2022
NARRATIVE
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Investigation Revealed the following.
Regarding Allegation:

Staff do not ensure the residents are being properly fed while in care

The complainant alleges staff do not ensure residents are being properly fed. LPA spoke to administrator S1 who denied the allegation. Administrator added that residents are fed three meals per day along with snacks and food on request. Administrator also stated, “we have 7 residents that require their food to be chopped for ease of swallowing and those residents are assisted with feeding when needed”. LPA has interviewed staff S2 memory care floor manager S2 denied the allegation and confirmed 7 memory care residents receive their food cut into smaller pieces for ease of swallowing and stated “all residents receive three meals per day and offered snacks residents that require assistance with feeding are fed by staff ”. LPA observed breakfast and lunch being served to all residents on three floors, meals were robust, LPA observed residents eating and drinking liquids as well as water, residents affect was pleasant. LPA interviewed S3 facility cook who stated “ I cook three meals per day for all residents and snacks, if resident request additional food sandwiches” LPA interviewed S4 Med Tech who was asked if residents were monitored for their weight S4 stated “residents are weighed monthly during doctors visits and provided to the doctor”. LPA interviewed residents (R1-R7) regarding the allegation of ensure residents are being properly fed. Residents interviewed all denied the allegation (R1-R7) residents are not being properly fed while in care. LPA interviewed staff (S1-S4)

SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Jeremiah RandleTELEPHONE: (323) 213-1116
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 11-AS-20221031142345
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: 11/08/2022
NARRATIVE
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regarding allegation staff do not ensure residents are being properly fed all staff denied the allegation.

Based on information gathered, the department did not find sufficient evidence to support allegation " Staff do not ensure the residents are being properly fed while in care

Regarding Allegation:

Residents are not consuming an appropriate amount of water while in care

The complainant alleges residents are not consuming an appropriate amount of water while in care. LPA interviewed administrator S1 who denied the allegation. S1 stated “water is available to all residents anytime”. LPA toured the facility with S1, S1 showed LPA water containers at the bedside of residents on floors 1-3. LPA observed water, tea, and juices provided at breakfast and lunch. LPA interviewed residents regarding allegation: residents are not consuming an appropriate amount of water while in care. Residents (R1-R7) denied the allegation. LPA interviewed residents (R1-R7) LPA asked residents if they had any problems getting water to drink at any time, all residents stated “no”. LPA interviewed staff (S1-S4) regarding allegation, residents are not consuming an appropriate amount of water while in care, LPA asked staff S1-S4 if water is readily available to all residents staff S1-S4 all stated “yes”.

SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Jeremiah RandleTELEPHONE: (323) 213-1116
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 11-AS-20221031142345
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: 11/08/2022
NARRATIVE
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Based on information gathered, the department did not find sufficient evidence to support allegation " Residents are not consuming an appropriate amount of water while in care.

Finding

The Department’s investigation consisted of an inspection of the facility, observation, analysis of facility records and interviews conducted and found no evidence to support the allegations:


Staff do not ensure the residents are being properly fed while in care.

Residents are not consuming an appropriate amount of water while in care


Although the allegations may have happened or are 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 Woohyun Park and a hard copy was provided.
SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Jeremiah RandleTELEPHONE: (323) 213-1116
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4