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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603283
Report Date: 09/15/2022
Date Signed: 09/15/2022 03:22:25 PM

Substantiated


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
09/09/2022 and conducted by Evaluator Cynthia D Chan
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220909155303
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: 3DATE:
09/15/2022
UNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Rebeca Martinez, StaffTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff did not allow client to leave facility.
Personnel records are not up to date with training certificates.
Client's behavioral plan is not included in the client record.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation for the allegations listed above. LPA arrived unannounced and met with Staff, Rebeca Martinez. The purpose of the visit was discussed. The Administrator, Victor Mora, was not present and interview was held via telephone.

During the visit today, LPA reviewed files for 4 Clients and Staff training logs. Interviews were held with the Administrator, 3 Staff, 2 Clients, and the San Gabriel/Pomona Regional Center Quality Assurance staff. Client #1 is no longer residing at the facility and LPA attempted to interview client but was unsuccessful today.

The investigation revealed the following:
For allegation – Staff did not allow resident to leave facility. It is alleged that Client (C-1) was not allowed to leave the facility one time during the night and/or next morning. LPA interviewed the Administrator and 3 Staff. The Administrator stated he verbally redirected the client since client was upset.
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022
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 4
Control Number 28-AS-20220909155303
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: 09/15/2022
NARRATIVE
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He asked the client to come back inside the home in which client complied and settled down. 2 of the 3 staff stated when C-1 leaves the facility, whether announced or unannounced, they would follow client as they verbally redirect. Another staff admitted to sitting down by the door one time to prevent C-1 from leaving the house due to client being angry. Staff did not want client to run out into the street and that it is their responsibility to keep the clients safe. Staff also stated that the other times C-1 left the house, staff would follow the client. LPA interviewed 2 Clients today. One of the clients observed staff standing in front of C-1 to prevent client from leaving the house. However, both clients stated staff allow them to leave the facility without any issues.

Allegation – Personnel records are not up to date with training certificates. Administrator stated the Staff have received the required training when they were first employed, and the Staff records are at the facility. The Staff assisting LPA could not find any Staff files but only a binder with training logs. LPA reviewed the 2 training logs dated back in October 2021 which were on medication training and maintaining a safe physical environment. Staff interviewed stated they will have their CPI training tomorrow. Based on observation, the staff files are not maintained at the facility and their training are not fulfilled.

Allegation – Client’s behavioral plan is not included in the client records. Per the Administrator, each of the clients behavioral plan is in the client’s file. He stated the behavioral treatment plan are updated every 6 months or a year. In regards to C-1, client moved in on 7/22/22 and was using the behavior plan from the previous facility at that time. Administrator stated he was required to have C-1’s behavior plan within 30 days of admission and was planning to update it but C-1 moved out. LPA reviewed 4 client files today. Client #2 has a behavioral treatment plan dated 8/20/21 on file, which is past the annual renewal. Client #4 does not have a behavioral treatment plan and was admitted on 7/19/22.

Based on LPA observations, interviews conducted and record review, the preponderance of evidence standard has been met, therefore, the above allegations are found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6 and Chapter 1), are being cited on the attached LIC 9099D.



An exit interview was conducted. The Plan of Corrections were reviewed and developed with Staff. A copy of this report and appeal rights were provided.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 28-AS-20220909155303
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/15/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/30/2022
Section Cited
CCR
80072(a)(6)
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80072 Personal Rights (a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following: (6) To leave or depart the facility at any time.
This requirement is not met as evidenced by:
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The licensee shall ensure staff allow the clients to leave the facility any time. A training log on personal rights shall be submitted to LPA by POC due date 9/30/22.
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Based on interviews, Staff tried to prevent Client #1 from leaving the facility which poses a potential personal rights risk for clients in care.
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Type B
09/30/2022
Section Cited
CCR
80065(f)
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80065 Personnel Requirements (f) All personnel shall be given on-the-job training or shall have related experience which provides knowledge of and skill in the following areas, as appropriate to the job assigned and as evidenced by safe and effective job performance.
This requirement is not met as evidenced by:
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The licensee shall ensure all staff receives the required annual training. The licensee shall submit documentation of training provided to staff by POC due date 9/30/22.
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Based on record review, the staff did not have sufficient annual training which 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.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 28-AS-20220909155303
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/15/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/30/2022
Section Cited
CCR
80066(c)
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80066 Personnel Records (c) All personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours.
This requirement is not met as evidenced by:
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The licensee shall ensure staff files are maintained and available for CCL to inspect. Licensee shall submit a statement acknowledging review of this regulation by POC due date 9/30/22.
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Based on observation, the Staff files were not available at the facility for LPA to review which poses a potential health and safety issue to clients in care.
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Type B
09/30/2022
Section Cited
CCR
80068.3(a)
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80068.3 Modifications to Needs and Services Plan (a) The licensee shall ensure that each client's written Needs and Services Plan is updated as often as necessary to assure its accuracy, but at least annually. These modifications shall be maintained in the client's file.
This requirement is not met as evidenced by:
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The licensee shall ensure the Behavioral Treatment plan are updated annual or as needed. The licensee shall provide a copy of the Behavioral Treatment Plan for C2 & C4 by POC due date 9/30/22.
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Based on record review, the licensee did not ensure the Behavioral Treatment Plan or updated plan for C2 and C4 are maintained in their files which poses a 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.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4