197608842-8-9-2023-11-AS-EMAZ-CUQTU8-20230815150156

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608842
Report Date: 08/09/2023
Date Signed: 08/09/2023 03:10:43 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
12/19/2022 and conducted by Evaluator Elizabeth Ceniceros

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20221219110219

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: 84	DATE:	08/09/2023
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Administrator Steve Cho		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff did not follow proper Covid-19 safety protocols.
Staff are not allowing resident to have visitors while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA)/Retired Annuitant (RA) Elizabeth Ceniceros made an unannounced visit to the facility and was greeted by Administrator (A2: Steve Cho). LPA/RA conducted a risk assessment prior to entering facility. A2 informed LPA/RA that the facility has no COVID cases nor do residents or staff have symptoms. The purpose for today’s visit is to conduct a subsequent visit to deliver the findings pertaining to the above-mentioned allegations.

An initial 10-Day visit was conducted by LPA Martessa Brown on 12/23/22 who was met by (former) Administrator (A1: Jason Park). During that visit, LPA conducted interviews with Staff #1 - #4 (S1-S4). LPA interviewed Resident #4 (R4) and utilized the translation line to assist with interviewing Residents #1 - #3 (R1-R3). LPA toured the facility’s physical plant for health and safety purposes and to ensure the wellbeing of residents in care. LPA reviewed and obtained copies of the following documents: resident and staff rosters, incident report(s), house rules, and pertinent information regarding the above-mentioned allegations. During today’s visit, RA Ceniceros observed the residents in the activity room for Kareoke.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Elizabeth Ceniceros	TELEPHONE: (916) 224-1579
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20221219110219

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: 08/09/2023

NARRATIVE

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Regarding Allegation #1: this investigation revealed based on interviews conducted with Staff #1 - #4 (S1-S4), Residents #1 - #4 (R1-R4), and a review of the requested documents that the facility is following COVID-19 protocols. Administrator Park informed LPA Brown that the facility follows COVID-19 protocols during a COVID outbreak - including the facility’s mitigation plan. Administrator informed LPA that there is a weekly COVID testing for staff and residents and whenever there is a positive case, it’s reported to CCLD (via fax) and to the local public health department (via RedCap). Administrator also stated to LPA that facility staff encourages their residents to wear a face mask when inside or outside the facility. LPA conducted an inspection and observed the facility is following their mitigation plan measures. LPA interviewed four (4) facility staff members and 4 of the 4 staff members interviewed corroborated that they have been trained in COVID protocol procedures and that staff encourages the residents to wear their face mask while inside or outside the facility. LPA interviewed four (4) residents and 4 of the 4 the residents corroborated facility staff are following COVID-19 procedures when there are positive cases. Residents also confirmed that the facility provides them with face masks to use while inside or outside the facility. A review of the facility’s COVID-19 incident reports that were submitted to CCLD (via fax) documented notifications made to DPH (via RedCap) that was confirmed by Administrator Park. A review of the facility’s staff training records documented staff were provided with “COVID-19” training on various topics (i.e., Cleaning for COVID-19 (05/30/22); Guidance on 2019 Novel Corona Virus or COVID-19 (06/01/22); Donning & Duffing (06/14/22), Handwashing & 6-feet Distancing (06/16/22); Mask FIT Testing (06/17/22); Cough Ettiquette & Cleaning for COVID-19 (06/18/22).

Based on the evidence gathered, interviews conducted, and records reviewed, 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 of OTHER: Staff did not follow proper Covid-19 safety protocols is found to be UNSUBSTANTIATED.

Regarding Allegation #2: this investigation revealed based on interviews conducted with Staff #1 - #4 (S1-S4), 4 of the 4 corroborated that staff do allow residents to have visitors. Administrator Park informed LPA Brown that during a COVID outbreak facility staff will contact the resident’s responsible person and encourage the family member(s) not to visit their loved one(s) while the resident(s) is in quarantine, and/or until their test result returns negative. In the memory care unit, visitors would visit their loved one(s) in the patio area. Facility encouraged an appointment to let facility staff know when a resident’s family was coming to visit their loved one at the facility to make sure there was enough space and to get the resident to the patio area for visitation. Administrator Park confirmed that when the facility had an outbreak, facility staff asked

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Elizabeth Ceniceros	TELEPHONE: (916) 224-1579
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20221219110219

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: 08/09/2023

NARRATIVE

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resident’s family to call ahead because the facility did not want to have a lot of visitors in one space to avoid spreading the virus. Although some resident’s family member(s) would show up unannounced to the facility, they would agree to visit their loved ones outside the resident(s) room and were never denied visitation. Interviews conducted with Residents #1 - #4, (R1-R4) 4 of the 4 the residents corroborated that facility staff allowed them to have visitors during COVID and were never denied of their visitation rights. RA Ceniceros observed COVID postings at the main entrance of the facility (photo). A review of the facility’s staff training records documented staff were provided with “PERSONAL RIGHTS” training on various topics (i.e., HIPPA Compliance (10/26/22) and Resident's Rights (12/22/22).

Based on the evidence gathered, interviews conducted, and records reviewed, 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 of PERSONAL RIGHTS: Staff are not allowing resident to have visitors while in care is found to be UNSUBSTANTIATED.

An exit interview has been conducted and a copy of the Complaint Report was provided to the new Administrator (Steve Cho).

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Elizabeth Ceniceros	TELEPHONE: (916) 224-1579
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023

LIC9099 (FAS) - (06/04)

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