198603294-5-29-2025-11-AS-SCIS-DKQT7D-20250820142825

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603294
Report Date: 05/29/2025
Date Signed: 05/29/2025 03:23:24 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
05/21/2025 and conducted by Evaluator Felisa Shirley

COMPLAINT CONTROL NUMBER: 11-AS-20250521114438

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:	DATE:	05/29/2025
		UNANNOUNCED	TIME BEGAN:	03:08 PM
MET WITH:	Mary Jane Montiano, Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Licensee did not ensure written notice of rate increase was provided to residents in care
Staff does not ensure facility is kept free of pests for residents in care

INVESTIGATION FINDINGS:

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*This report supercedes the investigation report delivered on 5/29/25. The purpose for this report is to provide additional information and does not change the investigation findings.

On 5/29/25 Licensing Program Analyst (LPA) Felisa Shirley, conducted an unannounced complaint visit to the address listed above. LPA Shirley arrived and spoke to the Administrator, Mary Jane Montiano and the purpose of the visit was discussed. LPA was granted access to the facility.

The investigation consisted of the following:
On 5/29/25 LPA requested and reviewed copies of the following records: Client files, Client Roster, Staff roster, Identification and Emergency Information, Admission Agreements for 10/5/23 and 1/1/25, PIN 24-13-CCLD, Application Summary for Supplemental Security Income, Appointment Notice and fumigation service records from Ojeda Pest Control for 5/28/25, 4/30/25 and 3/26/25. LPA Felisa Shirley conducted a tour of the facility. LPA Shirley interviewed Staff 1 – Staff-6 and Client 1 – Client 6.
Con'd on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2025

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-20250521114438

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: 05/29/2025

NARRATIVE

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The investigation revealed the following:

Allegation: Licensee did not ensure written notice of rate increase was provided to residents in care

On 5/29/25, LPA Shirley reviewed PIN 24-13-CCLD regarding Estimated SSI/SSP Payment Standards Effective January 1,2025 dated 11/18/2024. During file review, LPA Shirley observed the Admission Agreement for C-1 for the 2025 year, which was signed by C-1 on 1/1/25. Review of the Admission Agreement, LPA Shirley observed the section, Notice of Rate Change, which states, if rates are increased, the resident or authorized representative will be given at least 30 days written notice of the change. However, residents whose care is funded at rates prescribed by government funded programs may have the basic rate change effective on the operative date of any rate change made of that program without notice.

LPA interviewed staff, staff 1 – staff 6 (S-1 – S-6). LPA asked, does the Licensee ensure that written notices of rate increases are provided to residents in care. Of those interviewed 4 out of 6 stated yes, and 2 did not know. LPA interviewed client 1 – client 6 (C-1 – C-6). LPA asked clients, does staff ensure that written notices of rate increases are provided to residents in care. Of those interviewed, 4 out of 6 answered yes, and 2 answered no.

Based on records review, interviews and observations, LPA did not find sufficient evidence to support the above allegation. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is Unsubstantiated.

Con'd on 9099-C

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20250521114438

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: 05/29/2025

NARRATIVE

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Allegation: Staff does not ensure facility is kept free of pests for residents in care

On 5/29/25, LPA Felisa Shirley reviewed Fumigation service slips from Ojeda Pest Control dated 3/26/25, 4/30/25 and 5/28/25 in which the Administrator stated that this facility is serviced for general pest every month. Service slips indicated the areas that were treated on that specific date. LPA Shirley spoke to the representative for Ojeda Pest Control regarding treatment at this facility and LPA Shirley was told that Sunshine Assisted Living had not been treated for bed bugs in a very long time. When pest control comes out to treat the facility is usually in general areas unless given specific instructions to treat a specific area. LPA Felisa Shirley conducted a facility tour which included client’s rooms 1,7 and 19. LPA Shirley did not observe any sign of bed bugs.

LPA interviewed staff, staff 1 – staff 6 (S-1 – S-6). LPA asked, does staff ensure that this facility is kept free of pest for residents in care. Of those interviewed 6 out of 6 stated yes. LPA interviewed client 1 – client 6 (C-1 – C-6). LPA asked, does staff ensure that this facility is kept free of pest for the resident in care. Of those interviewed, 5 out of 6 answered, yes and 1 answered no.

Based on records review, interviews and observations, LPA did not find sufficient evidence to support the above allegation. 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 deficiencies were cited for these allegations.

An exit interview was conducted and a copy of this report was provided to the Administrator, Mary Jane Montiano.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2025

LIC9099 (FAS) - (06/04)

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