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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603294
Report Date: 12/05/2024
Date Signed: 12/05/2024 01:43:30 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/25/2024 and conducted by Evaluator Jose Calderon
COMPLAINT CONTROL NUMBER: 11-AS-20240725103218
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: 55DATE:
12/05/2024
UNANNOUNCEDTIME BEGAN:
01:34 PM
MET WITH:ADMINISTRATOR MARY MONTIANOTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Resident sustained fracture while in care due to staff's neglect.
INVESTIGATION FINDINGS:
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Community Care Licensing Division (CCLD) staff conducted an unannounced visit to Sunshine Assisted Living Facility on 12/05/2024 and was greeted by Administrator Mary Montiano (S1). CCLD staff explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegation.

CCLD investigation consisted of the following: CCLD staff interviewed Administrator (S1), staff (S2-S5), residents (R1-R3). CCLD staff requested and reviewed copies of the following: Physician Report (dated 07/04/2024), Needs and Services Plan (dated 07/05/2024), incident report (dated 07/18/2024, 07/21/2024, 07/22/2024), report of behavior observed by staff (dated 07/16/2024, 07/17/2024), caregivers schedule (July 2024), St. Francis Medical Center (date 07/18/2024 to 07/21/2024).

CCLD staff investigation revealed the following:

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024
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-20240725103218
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: SUNSHINE ASSISTED LIVING
FACILITY NUMBER: 198603294
VISIT DATE: 12/05/2024
NARRATIVE
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Regarding Allegation #1: Resident sustained fracture while in care due to staff’s neglect.

It is being alleged that R1 fell and fractured R1 hip due to staff neglect. CCLD staff toured the facility with S1. During tour of the facility CCLD staff noted facility staff helping residents and cleaning the facility. CCLD staff reviewed incident reports (date 07/18/2024, 07/21/2024, 07/22/2024) R1 had 3 unwitnessed falls and staff helped R1 off the floor and called 911. Reviewed needs and service plan (date 07/05/2024), R1 has medical issues but can-do own ADL’s with minimum assistance from staff. Reviewed Physician report (date 07/04/2024), R1 has health issues, ambulatory, no cognitive issues. CCLD staff interviewed S1-S5. 5 out of 5 staff indicate that R1 did not have an unwitnessed fall due to staff neglect. CCLD staff interviewed R1-R3. R1 indicates that R1 did not like using R1 walker. R1 could not recall how R1 fell but indicated the fall occurred at night. R1 indicated that if R1 needed assistance the staff would help R1. 2 out of 2 residents indicate that staff would help R1 after a fall. 2 out of 2 residents indicate that they never witnessed anything concerning at the facility. CCLD staff investigation findings: the interviews of clients/residents revealed they felt safe at the facility and had no concerns with the level of care provided by staff. Therefore, the allegation that R1 sustained a serious injury (hip fracture) due to staff neglect while in care of the facility is Unsubstantiated”.

Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has not been met; therefore, the allegation of “resident sustained fracture while in care due to staff’s neglect” is found to be UNSUBSTANTIATED.



No deficiencies cited during today's visit.

An exit interview was conducted, and a copy of the Complaint Report was provided to the Administrator Mary Montiano S1.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2