198603294-5-16-2025-11-AS-UCOL-DH9SZP-20250602141928

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603294
Report Date: 05/16/2025
Date Signed: 05/16/2025 12:42:41 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, 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
04/29/2025 and conducted by Evaluator Socorro Leandro

COMPLAINT CONTROL NUMBER: 11-AS-20250429120514

FACILITY NAME:	SUNSHINE ASSISTED LIVING		FACILITY NUMBER:	198603294
ADMINISTRATOR:	MARY MONTIANO		FACILITY TYPE:	735
ADDRESS:	3141 EUCLID AVE		TELEPHONE:	(310) 638-3847
CITY:	LYNWOOD	STATE: CA	ZIP CODE:	90262
CAPACITY:	68	CENSUS: 64	DATE:	05/16/2025
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Administrator - Mary Montiano		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff neglect resulted in a client sustaining a pressure injury

INVESTIGATION FINDINGS:

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On 05/16/2025, the California Department of Social Services (CDSS) Community Care Community Care Licensing (CCL) Licensing Program Analyst (LPA) Socorro Leandro conducted a subsequent complaint visit regarding the allegation above. LPA met with Administrator, Mary Montiano and explained the purpose of the visit. LPA was granted entry to the facility.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2025

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 3

Control Number 11-AS-20250429120514

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: SUNSHINE ASSISTED LIVING	FACILITY NUMBER: 198603294
	VISIT DATE: 05/16/2025

NARRATIVE

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The investigation consisted of the following:

On 04/30/2025, the department conducted a health and safety check of the residents in care and gathered client and staff records.
On 05/02/2025, the department provided the correct LIC9099 form to the facility. On 05/12/2025, the department interviewed Witness 1 (W1).
On 05/14/2025, the department interviewed W1.
On 05/16/2025, the department reviewed records and interviewed 3 staff. Interviews conducted consisted of Staff1 (S1) to Staff 3 (S3). The department reviewed Client 1’s (C1) records which consisted of their Physicians Report dated 12/12/2024; Admission Agreement dated 12/16/2024; Preplacement Appraisal Information dated 12/17/2024; Sample Body Check Form dated 12/17/2024; Hospice Notes for the Month of April 2025; Appraisal and Needs Services Plan dated 12/16/2024 and other pertinent documents.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20250429120514

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: SUNSHINE ASSISTED LIVING	FACILITY NUMBER: 198603294
	VISIT DATE: 05/16/2025

NARRATIVE

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The investigation revealed the following: Allegation: “Staff neglect resulted in a client sustaining a pressure injury”, it is being alleged that C1 developed a pressure injure while in care. Interviews conducted with S1 to S3 revealed the following: 3 out of 3 staff denied the allegation and indicated that they did not see a pressure injury on C1. Interviews conducted with W1 revealed the following: W1 denied the allegation. Furthermore, W1 indicated that there are no hospital medical records stating that C1 has a pressure injury, moreover, C1 was checked by nurses and wound care nurses when they came to the hospital (on 04/28/2025) and no pressure injuries were noted. Additionally, C1 was checked by wound care nurses on 05/13/2025 and no pressure injuries were noted. C1’s records reviewed revealed the following: there is no documentation stating pressure injuries or skin breakdown. In addition, C1 was seen by a Hospice Aid once a week; by a Licensed Vocational Nurse two to three times a week; and by a Registered Nurse (RN) twice a week according to hospice records for the month of April 2025. Furthermore, there is no mention of pressure injuries or skin breakdown documented by hospice staff. Based on interviews and records this allegation is unsubstantiated. Unsubstantiated: 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.

No citations were provided.

An exit interview was conducted, and a copy of this report was left with Administrator, Mary Montiano.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2025

LIC9099 (FAS) - (06/04)

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