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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602154
Report Date: 06/14/2022
Date Signed: 06/14/2022 04:04:26 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/10/2022 and conducted by Evaluator Jey Cardenas
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20220610100809
FACILITY NAME:SUNSHINE RESIDENTIAL HOME 2FACILITY NUMBER:
198602154
ADMINISTRATOR:JOSE, OYINLOYEFACILITY TYPE:
735
ADDRESS:3500 W 67TH STREETTELEPHONE:
(323) 521-6350
CITY:LOS ANGELESSTATE: CAZIP CODE:
90043
CAPACITY:4CENSUS: 4DATE:
06/14/2022
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Marla BolandTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff do not properly supervise residents
Staff did not assist resident with showering
Staff do not answer facility phone calls
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jey Cardenas conducted an initial 10-day complaint visit to the above facility to investigate allegations listed above. Upon arrival at the facility LPA meet with Staff#1 (S1). LPA explained the reason for today’s visit and conducted a Covid-19 risk assessment, based on the assessment facility is clear of covid-19 infection.

The investigation consisted of following LPA Cardenas interviewed Administrator, Jose (Jospeh) Oyewole via telephone, Staff#1-Staff#3 (S1-S3), client#1 and client#3 (C1, C3). Unable to interview C2 due to disability, C4 was not at facility at time of visit. LPA obtained the following: Client and staff roaster, client appraisal, daily facility notes, LPA toured physical plant.

-Regarding allegation- Staff do not properly supervise residents. Its is being alleged that staff are sleeping on the job, consequently unavailable to supervise nor assist clients with showering. On 6/14/22 LPA interviewed administrator, he indicates that the facility is equipped with surveillance cameras and he
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Jey Cardenas
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2022
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 5
Control Number 11-AS-20220610100809
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754
FACILITY NAME: SUNSHINE RESIDENTIAL HOME 2
FACILITY NUMBER: 198602154
VISIT DATE: 06/14/2022
NARRATIVE
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(continued pg2)

has not observed staff sleeping while on the job; this would be a cause for termination. None of the clients have reported observing staff sleeping on the job. During interview with C1 and C3 they indicated that they have not witnessed staff sleeping while on the job. S1-S3 denied witnessing staff sleeping while on the job and none of the clients have reported incidents.

-Regarding allegation Staff did not assist resident with showering. Per Appraisal dated 3/02/2020 C1 requires help with bathing, hair care, personal hygiene. NO assistance with toileting including assistance with equipment or assistance of another person. Per Individual Program Plan dated 02/10/2016 C1 performs personal care activities independently when reminded. C1 requires no assistance completing any toileting tasks. During interview with C1 client indicates that staff assist with showering and are available when needed. However, there’s incidents where staff can take up to five minutes to assist with toileting (no specific dates provided). C3 states staff area available to assist when needed, but for the most part client is self-sufficient. S1-S3 indicated that staff is available at all times to assist with showering. None of the clients have complained to staff that there was a time when staff was unavailable to shower client.

-Regarding allegation Staff do not answer facility phone calls- It is being alleged that on 06/08/22 call was made to the facility phone about three times and there was no answer. During interview with administrator, he states that the phone is working condition and staff answer calls when they come in. On 6/14/22 LPA Cardenas called facility phone number, and call was answered promptly. C3 indicates that there has been times when they call the facility, and the staff answer promptly. During interview with staff, staff indicated that the phone doesn’t make outbound calls, but all staff have a cellphone.

Based on LPA’s interviews and record reviews, LPA did not find sufficient evidence to support the allegations, Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegations are UNSUBSTANTIATED.

SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Jey Cardenas
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/10/2022 and conducted by Evaluator Jey Cardenas
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20220610100809

FACILITY NAME:SUNSHINE RESIDENTIAL HOME 2FACILITY NUMBER:
198602154
ADMINISTRATOR:JOSE, OYINLOYEFACILITY TYPE:
735
ADDRESS:3500 W 67TH STREETTELEPHONE:
(323) 521-6350
CITY:LOS ANGELESSTATE: CAZIP CODE:
90043
CAPACITY:4CENSUS: 4DATE:
06/14/2022
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:TIME COMPLETED:
03:30 PM
ALLEGATION(S):
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3
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Staff do not report incidents to appropriate parties
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jey Cardenas conducted an initial 10-day complaint visit to the above facility to investigate allegations listed above. Upon arrival at the facility LPA meet with S1 . LPA explained the reason for today’s visit and conducted a Covid-19 risk assessment, based on the assessment facility is clear of covid-19 infection.

The investigation consisted of following LPA Cardenas interviewed Administrator, Jose (Jospeh) Oyewole via telephone, Staff#1-Staff#3 (S1-S3), client#1 and client#3 (C1, C3). Unable to interview C2 due to disability, C4 was not at facility at time of visit. LPA obtained the following: Client and staff roaster, client appraisal, daily facility notes, LPA toured physical plant.

Regarding allegation Staff do not report incidents to appropriate parties. During file review daily notes, LPA observed that C1 and C2 were involved in a physical altercation- Notes dated 5/27/22- C1 hit C2 on the leg with a chair, 911 was called and C1 was hospitalized.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Jey Cardenas
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 11-AS-20220610100809
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754

FACILITY NAME: SUNSHINE RESIDENTIAL HOME 2
FACILITY NUMBER: 198602154
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/16/2022
Section Cited
CCR
80061(a)
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Each licensee or applicant shall furnish to the licensing agency reports as required by the Department...This requirement not met as evidenced by: On 6/14/22 LPA wasn't able to locate incident report in RO internal UIR folders,
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Facility administrator will ensure title 22 regulations are reviewed and submit self certification indicating regulations have been reviewed and is in understanding of reporting requirements.
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& administrator ddint furnish a fax confirmation transmittal sheet. This poses a potential health and safety risk to clients 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: Angela J Kendrick
LICENSING EVALUATOR NAME: Jey Cardenas
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 11-AS-20220610100809
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754
FACILITY NAME: SUNSHINE RESIDENTIAL HOME 2
FACILITY NUMBER: 198602154
VISIT DATE: 06/14/2022
NARRATIVE
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On 6/14/22 LPA Cardenas interviewed administrator, he indicates that unusual incident report (UIR) was submitted to CCL and Regional Center via fax. LPA requested the transmittal confirmation page showing date, time, and the fax number that the UIR was submitted to. On 6/14/22 at approximately 1:56pm Administrator emailed LPA UIR, however LPA was unable to confirm that UIR was submitted to CCL due to fax confirmation page was unavailable. LPA reviewed facility profile and there were no notes indicating incident report was received by CCL. LPA reviewed department internal facility UIR folder and found UIRs for year 2021, zero (0) UIRs for year 2022. LPA contacted case carrying LPA Agard, who indicates he is not in receipt of UIR for this incident. LPA was unable to confirm that UIR for incident on 5/27/22 was submitted to Community Care Licensing (CCL) .

Based on LPA’s interviews and record review(s), the preponderance of evidence standard has been met. Therefore, the allegation, is found to be SUBSTANTIATED. California Code of Regulations, Title 22 are being cited on the attached LIC9099-D.

Exit interview conducted a copy of this report and appeal rights provided to facility staff.

SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Jey Cardenas
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 5