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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608842
Report Date: 11/07/2024
Date Signed: 11/07/2024 11:39:18 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 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
11/01/2024 and conducted by Evaluator Regina Cloyd
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20241101161633
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: 77DATE:
11/07/2024
UNANNOUNCEDTIME BEGAN:
08:31 AM
MET WITH:Administrator Steve ChoTIME COMPLETED:
11:55 AM
ALLEGATION(S):
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Staff unlawfully evicted a resident.
INVESTIGATION FINDINGS:
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The investigation consisted of the following:

On 11/07/2024, Community Care Licensing Division (CCLD) Staff conducted a complaint investigation at the above facility to address the following allegation. CCLD Staff met with Administrator Steve Cho and explained the purpose of the visit. CCLD Staff conducted resident and staff interviews and reviewed resident record.

Regarding the allegation "Staff unlawfully evicted a resident.”
Record review revealed that Resident #1 (R1) was admitted into the facility on 06/13/2023. Interview with the Administrator (S1) indicated R1 has not been served an eviction notice. S1 indicated that in 2023, a Funding Source stated it could pay the Assisted Living Waiver (ALW) Rate one month prior to R1’s admission but has yet to pay as of 11/07/2024. In July 2024, S1 asked the Funding Source and R1’s family if they could pay the normal rate as of January 1, 2024 to present. S1 indicated that R1's ALW is still pending and R1 has not been served an eviction. Continue to LIC9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2024
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 2
Control Number 11-AS-20241101161633
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: SUNNY HILLS ASSISTED LIVING (MEMORY CARE)
FACILITY NUMBER: 197608842
VISIT DATE: 11/07/2024
NARRATIVE
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Six out of six staff interviews, including S1, indicated there has not been any recent evictions and residents have not complained about being with an eviction. Six out of six resident interviews, including R1, indicated they have not been served an eviction notice. Five out of six residents indicated they are treated with dignity and respect. R1 did not understand the question.

Regarding the allegation “Staff unlawfully evicted a resident," based on record reviews and interviews, the Department found no evidence to support the allegation mentioned above. 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, as a result, the allegation is Unsubstantiated.

No deficiency was cited for this allegation.

An exit interview was conducted and a copy of this report was provided to the Administrator Steve Cho.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2