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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609897
Report Date: 11/01/2021
Date Signed: 11/02/2021 12:43:54 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
10/28/2021 and conducted by Evaluator Eleza Jackson
COMPLAINT CONTROL NUMBER: 31-AS-20211028083804
FACILITY NAME:SUNLAND COTTAGEFACILITY NUMBER:
197609897
ADMINISTRATOR:ORTIZ-LUIS,RHEAFACILITY TYPE:
740
ADDRESS:10942 QUILL AVETELEPHONE:
(818) 395-0517
CITY:SUNLANDSTATE: CAZIP CODE:
91040
CAPACITY:6CENSUS: 5DATE:
11/01/2021
UNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Annie BasillanTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Staff are not performing COVID screening tests for the public entering the facility.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Eleza Jackson responded to the facility to conduct an investigative visit in reference to the above listed allegations. Upon arrival, LPA Jackson made contact with staff Annie Basillan. Annie and I contacted Administrator Rehea Ortiz-Luis and requested she respond. Ms. Ortiz-Luis was unavailable. LPA Jackson conducted an interview with Annie. The following was determined. Staff did not check LPA Jackson’s temperature, nor did staff ask any covid screening questions, and there was no sign in/out book for visitors. Annie stated that the facility did not have one. Based on the information obtained LPA Jackson’s visit this allegation is deemed Substantiated at this time. Citation issued, appeal rights provided, Exit Interview was conducted.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Eleza JacksonTELEPHONE: (661) 361-6007
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2021
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 31-AS-20211028083804
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: SUNLAND COTTAGE
FACILITY NUMBER: 197609897
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/01/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/11/2021
Section Cited
CCR
87468.2(a)(2)
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Personal Rights of Residents in All Facilities-To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by:
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Administrator shall have in-service with facility staff on the importance of checking all visitors temperatures and following Covid protocols. Copy of in-service sign in sheet shall be sent to LPA.
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Based on LPA Jackson’s experience at unannounced visit; temperature was not checked and there was no evidence of a sign in/out book.
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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.
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Eleza JacksonTELEPHONE: (661) 361-6007
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2