198602882-9-29-2021-28-AS-CYEE-CD5TNQ-20220403145309

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602882
Report Date: 09/29/2021
Date Signed: 09/29/2021 01:05:35 PM

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
07/22/2021 and conducted by Evaluator Linda M Almaraz

COMPLAINT CONTROL NUMBER: 28-AS-20210722092130

FACILITY NAME:	SUNRISE ASSISTED LIVING OF CLAREMONT		FACILITY NUMBER:	198602882
ADMINISTRATOR:	MENSAH, ERIC		FACILITY TYPE:	740
ADDRESS:	2053 N TOWNE AVE		TELEPHONE:	(909) 398-4688
CITY:	CLAREMONT	STATE: CA	ZIP CODE:	91711
CAPACITY:	81	CENSUS: 56	DATE:	09/29/2021
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Executive Director, Kimberly Sanchez		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Residents belonging not being safeguarded.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Linda Almaraz conducted a subsequent complaint visit to investigate the allegation listed above. LPA was greeted by Executive Director Kimberly Sanchez and at about 11:20AM the facilities new Administrator, Roger Endert met with LPA. LPA disscused the reason for todays visit.

The investigation consisted of the following: On 7/28/21, LPA's Nina Galarza and Linda Almaraz requested staff and resident roster, interviewed former Administrator Jennifer Serrano, Staff #1 and Resident #1. LPA's also requested Resident #1's file, and reviewed residents file. On 9/29/21, LPA Almaraz interviewed Staff #2, and requested records pertainint to the allegation.

The investigation revealed the following: Based on interviews conducted and records reviewed, the resident was residing at Sunrise Assisted Living at San Marino and was later moved to Sunrise Assisted Living of Claremont around 9/30/2020. (Continued on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Linda M Almaraz	TELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20210722092130

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: SUNRISE ASSISTED LIVING OF CLAREMONT	FACILITY NUMBER: 198602882
	VISIT DATE: 09/29/2021

NARRATIVE

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It is alleged that during the residents stay at Sunrise Assisted Living at San Marino the residents Power of Attorney (POA) at the time, dropped off some gold necklaces at the front desk of the facility for the resident. Interviews conducted with staff and the resident indicated the necklaces were fantasy jewelry and not gold. The resident indicated they never received any gold jewelry from the POA and was having issues with the POA in regards to the residents finances. Claremont Police Department went out to the facility on 7/19/2021 and interviewed both parties in regards to jewelry and financial abuse. According to the police report, the case is being forwarded to the District Attorneys Office. The resident indicated the POA took the residents jewelry away back in 2019 prior to the resident moving into Sunrise Assisted Living at San Marino and is lying about dropping off jewelry. LPA could not confirm if the gold necklaces were dropped off by the POA at the previous facility or current facility, and if they were lost at the previous facility or at Sunrise Assisted Living of Claremont. Therefore, there is insufficient evidence to support the allegation.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

An exit interview was conducted with the Executive Director and Administrator and a hard copy was provided.

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Linda M Almaraz	TELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021

LIC9099 (FAS) - (06/04)

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