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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602881
Report Date: 03/15/2022
Date Signed: 03/16/2022 06:52:02 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 DR #100
MONTERY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/09/2022 and conducted by Evaluator Ernand Dabuet
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20220309162423
FACILITY NAME:SUNRISE VILLA CULVER CITYFACILITY NUMBER:
198602881
ADMINISTRATOR:COLLINS, BRANDONFACILITY TYPE:
740
ADDRESS:4061 GRAND VIEW BLVDTELEPHONE:
(310) 390-0565
CITY:LOS ANGELESSTATE: CAZIP CODE:
90066
CAPACITY:150CENSUS: 76DATE:
03/15/2022
UNANNOUNCEDTIME BEGAN:
09:37 AM
MET WITH:Safoora AhmedTIME COMPLETED:
04:11 PM
ALLEGATION(S):
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Facility food is not of good quality.
Food is served cold.
INVESTIGATION FINDINGS:
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On 03/15/22 Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced complaint visit at this facility. LPA met with Executive Director Safoora Ahmed and explained the purpose of today's visit is to gather information for the allegations mentioned above.

The investigation consisted of the following: LPA inquired questions relevant to the nature of the complaint. Interviews with staff #1 - #5 (S1-S5) and residents #1-#7 (R1-R7). A copy of resident #1-#3 (R1-R3) physician report. The facility menu and other documents pertinent to the allegation were examined. An inspection of the facility was conducted. An observation assessment of food preparation and service was conducted.

Evaluation Report continues on LIC 9099
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Ernand DabuetTELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:

DATE: 03/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2022
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 2
Control Number 11-AS-20220309162423
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: SUNRISE VILLA CULVER CITY
FACILITY NUMBER: 198602881
VISIT DATE: 03/15/2022
NARRATIVE
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INVESTIGATION REVEALED THE FOLLOWING:
Allegation: Facility food is not of good quality.
Food is served cold.
It is alleged the food quality is substandard and the temperature of meals are served cold. The complainant reports the vegetables are often undercooked and the meat is overcooked. The complainant added that several food items on the menu are served cold. The complainant also expressed the food is too salty and that management is aware of the issues and does nothing to correct the problems. However, the complainant is unable to provide names of staff detailed information such as dates and time of such incidents. An interview with staff #1-#5 (S1-S5) disputes knowing any residents having concerns of substandard food or meals served in cold temperature. Interviews conducted with residents #2-#7 (R2-R7) all expressed they had no issues with the quality, temperature, portions, options or variety. (R2-R5) who are on special diets claims the facility does provide nutritional options to accommodate their meet their dietary restrictions. The Department conducted an assessment between 12pm - 1pm and observed how meals were prepared and how meals were served. The Department noticed hot plates were under heat lamps and were carried out within two to three minutes at tables by servers. The meals are "made to order" customized to specifications from the standard quarterly menu or weekly menu with daily specials. The facility collaborates with Nutricopia nutritional consultants on all their menus. Interviews with (S2-S5) stated that residents have choices aside from what is on the regular menu and will be made upon request daily. Furthermore, residents have right to refuse if the temperature is not to their satisfaction and will be reheated or a new dish will be created. Interviews with (R2-R7) verified that they were aware of these options. The administrator reported that an open forum "Chef's Corner" an event held on 03/16/22 open to all residents to discuss their concerns with meals, suggestions, and amenities all related to food services. The facility has a suggestion box available in the dining room area to garner opinions or suggestions from residents, staff or visitors.

Based on information gathered, an inspection of the facility, observation, analysis records of service records, interviews, the Department found no evidence to support the allegations "Facility food is not of good quality" and "Food is served cold".

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.

An exit interview with Safoora Ahamed and a copy of the report were provided.
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Ernand DabuetTELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:

DATE: 03/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2