197609352-3-21-2025-31-AS-NGID-DH9RTN-20250602131833

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609352
Report Date: 03/21/2025
Date Signed: 03/21/2025 09:28:43 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 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
08/07/2024 and conducted by Evaluator Huma Rahimi

COMPLAINT CONTROL NUMBER: 31-AS-20240807101024

FACILITY NAME:	SUNSHINE RESIDENTIAL HOME 3		FACILITY NUMBER:	197609352
ADMINISTRATOR:	JOSE, OYINLOYE AUSTINE		FACILITY TYPE:	735
ADDRESS:	17915 HEMMINGWAY STREET		TELEPHONE:	(818) 666-5319
CITY:	RESEDA	STATE: CA	ZIP CODE:	91335
CAPACITY:	4	CENSUS: 4	DATE:	03/21/2025
		UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Toluwalope Jose, Administrator Designee		TIME COMPLETED:	09:50 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Client is being physically abused at the facility.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Huma Rahimi conducted an unannounced subsequent visit to this facility to deliver the final report. LPA met with the staff Trishana Thompson, and the Administrator Designee Toluwalope Jose was contacted via phone and LPA explained the reason for the visit. The Administrator Designee arrived shortly after.
On 08/07/2024, the Woodland Hills South Adult and Senior Care Regional Office received a complaint regarding allegations, “client is being physically abused at facility.” The complaint was referred to Community Care Licensing Division’s Investigations Branch. The complaint was assigned to investigator Laura Garcia.

On 08/08/2024 LPA Angela Panushkina and Ari Stark, Quality Assurance Specialist, North Los Angeles Regional Center conducted an initial 24-hour complaint visit. At 10:15 AM, LPA Panushkina requested copies of pertinent information which include, but not limited to Physician’s report, Admission Agreement,

Continue on LIC 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2025

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-20240807101024

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: SUNSHINE RESIDENTIAL HOME 3	FACILITY NUMBER: 197609352
	VISIT DATE: 03/21/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Appraisal Needs and Services Plan/Individual Program Plan (IPP), Staff Training, relevant to the investigation. LPA conducted a physical plant tour.
Investigator Laura Garcia conducted interviews with North Los Angeles Regional Center (NLARC) Case Manager on 08/11/2024, NLARC Community Service Specialist on 09/16/2024, the Administrator Designee on 09/12/2024, other witnesses on 08/08/2024, staff on 09/12/2024 and 09/13/2024. On 08/19/2024, Special Investigative Assistant (SIA) Jackson requested medical records and was received and reviewed on 09/06/2024. On 09/16/2024, additional medical records were reviewed.
Allegation: Client is being physically abused at the facility.

The investigation revealed that on 07/31/2024, Client #1 (C1) was taken to the hospital by their family member due to increased agitation and self-harm. It was alleged that C1 was abused physically at the facility by the direct support staff. The Investigator conducted an interview with the Administrator Designee, and she denied the allegation of physical abuse. Interview with the Administrator Designee also revealed that C1 required a higher level of care due to aggressive episodes; however, Regional Center (RC) assigned 1:1 caregiver, and the facility always provided an additional caregiver to provide proper care to C1. Interview with C1’s Case Manager (CM) from NLARC who is working with C1 for the past two years informed the Investigator about C1’s extensive history of self injurious behaviors and is unsure of the recent increase of agitation. CM believes that the medication could be the reason for the ongoing behavior. Furthermore, CM did not express any concerns of physical abuse by the facility staff. Interview conducted with the Consumer Services Specialist (CSP) from NLARC also confirmed C1’s self injurious behavior and did not suspect any physical abuse. Moreover, review of Individual Program Plan (IPP) of C1 also indicate the self injurious behavior which includes slapping, punching, scratching, and biting. Additionally, review of the medical records also revealed that C1’s self injurious behavior persisted during hospital stay. The medical records also indicated that the family member of C1 is the responsible person for C1’s medication administration and no new medication change was ordered by C1’s primary Physician. Both family members interviewed also confirmed C1’s self injurious behavior. One of the family members also confirmed the medication administration to C1. Furthermore, interview with direct support staff of C1 denied the allegation and informed the Investigator that C1’s aggressive behavior was worsening prior to his/her birthday. C1 was hitting himself/herself and others. Interview with other two staff also confirmed the information that C1 did have self injurious behaviors since the day of admission to the facility and got worse lately.

Continue on LIC 9099C

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 31-AS-20240807101024

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: SUNSHINE RESIDENTIAL HOME 3	FACILITY NUMBER: 197609352
	VISIT DATE: 03/21/2025

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32	Based on the above information, there is insufficient evidence to support the allegation of Physical Abuse. Therefore, the allegation is deemed Unsubstantiated at this time. No deficiency issued. Exit interview conducted and copy of this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 3