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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602615
Report Date: 10/15/2021
Date Signed: 10/15/2021 11:05:23 AM

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 CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/08/2021 and conducted by Evaluator Elizabeth Irra
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20211008164219
FACILITY NAME:SUNSHINE RESIDENTIAL HOMEFACILITY NUMBER:
198602615
ADMINISTRATOR:JOSE, OYINLOYE AUSTINEFACILITY TYPE:
735
ADDRESS:1159 E 68TH STTELEPHONE:
(323) 305-3552
CITY:LOS ANGELESSTATE: CAZIP CODE:
90001
CAPACITY:4CENSUS: 3DATE:
10/15/2021
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:S-1TIME COMPLETED:
09:45 AM
ALLEGATION(S):
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9
Facility has roaches.
INVESTIGATION FINDINGS:
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2
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4
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13
Licensing Program Analyst (LPA) Elizabeth Irra conducted the initial 10-day complaint visit to investigate the above allegation. LPA met with S-1 and discussed the purpose of today's visit. LPA interviewed Facility Administrator (Staff #2/S-2) via telephone.

During today's visit, LPA interviewed Staff #1 (S-1), Facility Administator (S-2), Staff #3 (S-3) and Staff #4 (S-4). LPA interviewed Client #2 and Client #3. LPA was unable to interview C-1 and C-1 is non-verbal. C-4 is no longer residing at this facility and is unreachable. LPA also conducted a tour of the facility.

Refer to LIC 9099C for the continuation of this report.

Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2021
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 28-AS-20211008164219
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 CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: SUNSHINE RESIDENTIAL HOME
FACILITY NUMBER: 198602615
VISIT DATE: 10/15/2021
NARRATIVE
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Allegation: Facility has roaches. During this investigation, LPA interviewed S-1 through S-4, C-2 and C-3. LPA was unable to interview C-1 as C-1 is non-verbal and C-4 as C-4 is no longer residing at this facility and is unreachable. Staff interviews revealed that they have not observed any roaches inside this facility. Interviewed staff indicated that each client has their own private bedroom. Interviewed staff indicated that C-4 did not allow any staff to enter C-4’s room (including cleaning of C-4’s room) and that C-4 had a lot of belongings and ate inside the bedroom. Interviewed staff indicated they have not observed any roaches nor received any complaints/concerns of this facility having roaches from anyone. Interviewed clients indicated that staff keep this facility clean and that they have not observed any roaches at this facility. LPA also conducted a tour of the facility and did not observe any roaches in the facility. Staff and client interviews and facility tour do not corroborate this allegation.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.



Exit interview conducted and Appeal Rights provided to the S-1
NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2