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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603283
Report Date: 08/29/2022
Date Signed: 08/29/2022 03:17:27 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 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
08/18/2022 and conducted by Evaluator Kruz Long
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220818145816
FACILITY NAME:VICTOR SUNSHINE RESIDENTIAL CAREFACILITY NUMBER:
198603283
ADMINISTRATOR:MORA, VICTOR OLIVER RFACILITY TYPE:
735
ADDRESS:1410 S. RIDLEY AVE.TELEPHONE:
(626) 346-3498
CITY:HACIENDA HEIGHTSSTATE: CAZIP CODE:
91745
CAPACITY:4CENSUS: DATE:
08/29/2022
UNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Karina Garcia (Direct Support Professional)TIME COMPLETED:
03:20 PM
ALLEGATION(S):
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Facility staff member physically assaulted resident causing injuries.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kruz Long delivered complaint finding at the facility. Upon arrival, LPA met with Karina Garcia (Direct Support Professional) and explained the purpose of the visit.

During the initial visit conducted on 08/19/22, LPA interviewed Staff #1 in the dining area, interviewed Staff #2 via telephone and interviewed Clients #2 and #3 in the dining area.

In regards to the allegation: Facility staff member physically assaulted resident causing injuries. Interviews with Clients indicated that on the day of the incident, Client #1 attempted to leave the facility and went outside to the front yard. Staff #2 went after Client #1 in an attempted to redirect Client #1 back into the facility. Client #1 became irate and threw oneself onto the grown causing scratches to the back and right arm. Once Client #1 came back into the facility, Client #1 again threw oneself onto the ground. Incident was witnessed by Client #2 and #3. Staff #2 denied physically assaulting Client #1 and also indicated that Client #1 threw oneself to the ground. Continue to LIC9099C....
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Kruz Long
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2022
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 28-AS-20220818145816
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: VICTOR SUNSHINE RESIDENTIAL CARE
FACILITY NUMBER: 198603283
VISIT DATE: 08/29/2022
NARRATIVE
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Based on LPA's interviews, the investigation revealed: 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.

Exit interview conducted with Karina Garcia (Direct Support Professional) and a copy of this report provided.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Kruz Long
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2