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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609352
Report Date: 03/11/2022
Date Signed: 03/11/2022 12:45:21 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/29/2020 and conducted by Evaluator Angela Panushkina
COMPLAINT CONTROL NUMBER: 31-AS-20200629074442
FACILITY NAME:SUNSHINE RESIDENTIAL HOME 3FACILITY NUMBER:
197609352
ADMINISTRATOR:JOSE, OYINLOYE AUSTINEFACILITY TYPE:
735
ADDRESS:17915 HEMMINGWAY STREETTELEPHONE:
(818) 666-5319
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY:4CENSUS: 4DATE:
03/11/2022
UNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Laila Kulungu, Administrator TIME COMPLETED:
01:10 PM
ALLEGATION(S):
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Staff failed to accord resident dignity and respect
INVESTIGATION FINDINGS:
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At 11:20 am, Licensing Program Analyst (LPA) Angela Panushkina conducted a subsequent complaint visit to deliver the finding of the allegation listed above. LPA met with the Administrator, who granted access to home. LPA explained the reason for the visit.

An initial 10-day visit was conducted on 07-06-2020 by LPA Gillyard. LPA toured the facility and interviewed the Administrator at 3:00 pm. LPA attempted to interview other clients, however, they were either not available and or unable to communicate. Client #1 was not available for interview.

LPA requesting relevant documentation for 1 out of 4 clients, which included the IPP (Individual Program Plan), behavior plan and Physician report for client #1(C1). Documentation was received 07-07-2020 and reviewed. LPA made contact with other witness and obtained text messaging documentation. LPA reviewed Corrective Action plan obtained from North Los Angeles County Regional Center (LACRC) on 06-29-2020.
Continue on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2022
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 31-AS-20200629074442
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: SUNSHINE RESIDENTIAL HOME 3
FACILITY NUMBER: 197609352
VISIT DATE: 03/11/2022
NARRATIVE
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The complainants concern is that the Administrator/facility designee exchanged inappropriate text communication in which client #1 (C1) and the clients’ 1:1 Staff #1 (S1) received.

On June 30, 2020 LPA received evidence of screen shot text between the Administrator/facility designee, C1 and S1 that took place on or about April 23, 2020. The written tone of the text from the Administrator was observed to be a violation of C1's personal rights.

In summary the written text from the Administrator stated that S1 would call the police and P.E.T (Psyche Evaluation Team) if the client stepped out of the front gate boundary. Then asked," If the client likes jail so much to send the client back". The Administrator expressed wanting restitution.

LPA reviewed C1's behavior plan. The text communication is not consistent with C1's Behavior Plan approach.

At 3:00 pm on 07-06-2020 the Administrator was interviewed and acknowledge the communication and agreed that the approach was inappropriate and stated that it will not happen again.

Therefore, the allegation, 'Staff failed to accord resident dignity and respect’ shall be substantiated. The Administrator and or any staff of the facility has a responsibility to be professional and approach each client with dignity and respect regardless of the issue.

Deficiency was issued per CA code of Regulations Title 22. See LIC9099-D included with this report.

Exit interview conducted, appeal rights discussed and copy of this report was provided to the Administrator.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 31-AS-20200629074442
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: SUNSHINE RESIDENTIAL HOME 3
FACILITY NUMBER: 197609352
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/11/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/12/2022
Section Cited
CCR
80072(a)(1)
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80072(a)(1) Personal Rights: Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following:

(1) To be accorded dignity in his/her personal relationships with staff and other persons.
This requirment is not met as evidenced by
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The Administrator has agreed to the following:
Provide personal rights training to all staff. Submit the staff sign in sheet and training material.
POC cleared during todays visit. Administrator emailed proof of training conducted on 07/15/20 to LPA.
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Based on evidence and interviews the Administrator engaged in inappropriate communication which did not accord C1 diginity and respect with staff.

This is a personal rights violation to the client in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2022
LIC9099 (FAS) - (06/04)
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