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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603294
Report Date: 11/04/2021
Date Signed: 11/08/2021 08:41:23 AM

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 DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/28/2021 and conducted by Evaluator Ulysses Coronel
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20211028075951
FACILITY NAME:SUNSHINE ASSISTED LIVINGFACILITY NUMBER:
198603294
ADMINISTRATOR:MARY MONTIANOFACILITY TYPE:
735
ADDRESS:3141 EUCLID AVETELEPHONE:
(310) 638-3847
CITY:LYNWOODSTATE: CAZIP CODE:
90262
CAPACITY:68CENSUS: 58DATE:
11/04/2021
UNANNOUNCEDTIME BEGAN:
09:31 AM
MET WITH:Marilyn NguyenTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Bathroom faucets do not deliver hot water.
Staff do not serve food of the quality necessary to meet residents needs.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Ulysses Coronel and LPA Gail Johnson initiated a complaint investigation for the allegations listed above. LPAs met with licensee Marilyn Nguyen and the purpose of the visit was explained.

The investigation consisted of the following: During todays visit LPAs and staff conducted a tour of the facility which included the dining area, kitchen, hallways, bedrooms and bathrooms. LPAs interviewed 6 out of 58 clients and 6 staff. LPAs reviewed and requested copies of facility, staff and client records.

The investigation revealed the folllowing:
Regarding the allegation; Bathroom faucets do not deliver hot water. During todays visit LPAs tested the water temperature and the water temparature tested between 77.5 and 78.0 F in the common bathrooms in the Main Building and between 138.0 and 142.0 F in the Annex Building. 3 out of 6 clients interviewed felt bad about the water temperature at the facility.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ulysses Coronel
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021
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 5
Control Number 11-AS-20211028075951
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
MONTEREY PARK, CA 91754
FACILITY NAME: SUNSHINE ASSISTED LIVING
FACILITY NUMBER: 198603294
VISIT DATE: 11/04/2021
NARRATIVE
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Client C1 stated "The water may stay cold while the kitchen is preparing food so we have to wait until a after meals to shower. But still it takes around 20 minutes for water to heat up. C6 stated the water is scorching hot." 3 out 6 clients felt good about the water temperature, client C4 stated "It's okay." Regarding the allegation; Bathroom faucets do not deliver hot water. Based on LPAs observations and interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 1 are being cited on the attached LIC9099D.

Regarding the allegation; Staff do not serve food of the quality necessary to meet residents needs. During todays visit LPA's observed that the food served during lunch was did no include certain food indicated in the facility menu for the day, fruit was not served. 4 out of 6 clients interviewed felt bad about the quality of food being served C2 stated "The food served during lunch and dinner are catered and not always warm when delivered and C3 stated "It's not good, not healthy, disgusting and eggs are too cold when served." 2 out of 6 clients stated they felt good about the food being served. C5 stated "The food is average, it's okay." Regarding the allegation; Staff do not serve food of the quality necessary to meet residents needs. Based on LPAs observations and interviews which were conducted and the records that were reviewed, the preponderance of evidence standard has been met, therefore the above allegation is 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, plan of corrections were developed. A copy of this report and appeals rights were discussed and provided to Licensee Marilyn Nguyen.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ulysses Coronel
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 11-AS-20211028075951
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
MONTEREY PARK, CA 91754

FACILITY NAME: SUNSHINE ASSISTED LIVING
FACILITY NUMBER: 198603294
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/04/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/05/2021
Section Cited
CCR
80088(e)(1)
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80088(e)(1) Furniture, Fixtures, Equipment, and Supplies. Faucets used by clients for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be ... not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C). This requirment was not met as evidenced by:
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The licensee agreed to create a plan ensuring that water temperature will not be less than 105 degrees F and not more than 120 degrees F. Proof of corrections will be due by POC Due date.
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Based on LPA observations and interviews conducted the hot water temperature was less than 105 F in the main building and more than 120 F in the Annex, the water temperature measeured between 77.5 and 78.0 F and 138.0 and 142.0 F which poses an immediate risk to the health and safety of clients in care.
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LPA may conduct an unannounced visit to observe if corrections were made.
Type B
12/04/2021
Section Cited
CCR
80076(a)(1)
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80076(a)(1) Food Services. In facilities providing meals to clients, the following shall apply: All food shall be safe and of the quality and in the quantity necessary to meet the needs of the clients. Each meal ...served. All food shall be selected, stored, prepared and served in a safe and healthful manner.
This requirement was not met as evidenced by:
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The Licensee agreed to submit the a plan to ensure the food served is safe and of the quality and quantity necessary to meet clients needs. Proof of Correction will be submitted by POC Due Date.
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Based on record reviews, LPA observation and interviews conducted the Licensee failed to ensure that all food were safe and of the quality and quantity necessary to meet clients needs. This poses a potential health and safety risk to clients in care.
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LPA may conduct an unannounced visit to observe if corrections were made.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ulysses Coronel
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 5
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
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/28/2021 and conducted by Evaluator Ulysses Coronel
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20211028075951

FACILITY NAME:SUNSHINE ASSISTED LIVINGFACILITY NUMBER:
198603294
ADMINISTRATOR:MARY MONTIANOFACILITY TYPE:
735
ADDRESS:3141 EUCLID AVETELEPHONE:
(310) 638-3847
CITY:LYNWOODSTATE: CAZIP CODE:
90262
CAPACITY:68CENSUS: 58DATE:
11/04/2021
UNANNOUNCEDTIME BEGAN:
09:31 AM
MET WITH:Marilyn NguyenTIME COMPLETED:
05:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Residents not accorded dignity in relationships with staff.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPA) Ulysses Coronel and LPA Gail Johnson initiated a complaint investigation for the allegations listed above. LPAs met with licensee Marilyn Nguyen and the purpose of the visit was explained.

The investigation consisted of the following: During todays visit LPAs and staff conducted a tour of the facility which included the dining area, kitchen, hallways, bedrooms and bathrooms. LPAs interviewed 5 out of 58 clients and 6 staff. LPAs reviewed and requested copies of facility, staff and client records.

The investigation revealed the folllowing: Regarding the allegation; Residents not accorded dignity in relationships with staff. During todays visit LPAs inteviewed 6 staff and 6 out of 58 clients. 6 out 6 staff interviewed denied observing residents not being treated with dignity and respect, staff S1 stated "It's actually the clients who are sometimes being rude with staff and some clients have certain conditions where they may perceive something that did not happen.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ulysses Coronel
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 11-AS-20211028075951
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
MONTEREY PARK, CA 91754
FACILITY NAME: SUNSHINE ASSISTED LIVING
FACILITY NUMBER: 198603294
VISIT DATE: 11/04/2021
NARRATIVE
1
2
3
4
5
6
7
8
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10
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12
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15
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5 out of 6 clients interviewed felt good about the way they were being treated by staff, C1 stated "Here they take time to know about us, they're friendly." 1 out of 6 clients did not provide answer. Regarding the allegation; Residents not accorded dignity in relationships with staff. 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. A copy of this report was discussed and provided to Licensee Marilyn Nguyen.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ulysses Coronel
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 5