198603294-10-3-2024-11-AS-UCOL-DA5QD8-20241017120417

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603294
Report Date: 10/03/2024
Date Signed: 10/03/2024 11:58:29 AM

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
11/08/2023 and conducted by Evaluator Socorro Leandro

COMPLAINT CONTROL NUMBER: 11-AS-20231108135030

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: 46	DATE:	10/03/2024
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Administrator Assistant - Sylvia Guevara		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Staff did not assist resident with administration of oxygen
Staff refused to seek medical attention for resident

INVESTIGATION FINDINGS:

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On 10/03/2024 at around 8:00 AM, Licensing Program Analyst (LPA) Leandro conducted an unannounced subsequent visit of a complaint investigation regarding the allegations listed above. LPA was met by Medical Technician Priscilla Barrera and LPA explained the purpose of the visit.

The investigation consisted of the following:
On 11/16/2023, LPA Leon interviewed 6 residents and 6 staff.
On 10/02/2024, LPA Leandro interviewed 4 residents and 1 staff. LPA Leandro gathered facility records and resident records.
On 10/03/2024, LPA Leandro interviewed 2 residents and 4 staff. LPA Leandro reviewed facility records and resident records.
A total of 12 out of 46 residents were interviewed and a total of 11 out of 25 staff were interviewed.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Socorro Leandro	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20231108135030

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: 10/03/2024

NARRATIVE

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The investigation revealed the following:

Regarding the allegation: “Staff did not assist resident with administration of oxygen”, it is being alleged that Resident 1 has a doctor’s order for oxygen, but staff said no. Interviews conducted revealed the following: 4 residents indicated that they have never been denied their medication and 6 residents denied the allegation. 7 staff denied the allegation. The Administrator, Medical Technician and staff explain that doctors give orders for oxygen and if they do not have an oxygen prescription from the doctor than they cannot provide residents with oxygen administration. Records review reveal the following: LPA Leandro did not observe an oxygen order for Resident 1. Regarding the allegation, the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the allegation is unsubstantiated.

Regarding the allegation: “Staff refused to seek medical attention for resident”, it is being alleged that a resident requested medical attention and asked for help, but staff said “no.” Interviews conducted revealed the following: 10 out of 12 resident interviews denied the allegation. 7 staff interviews denied that allegation. Regarding the allegation, the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the allegation is unsubstantiated.

No citations were issued. An exit interview was conducted, and a copy of this report was left with the Administrator Assistant Sylvia Guevara.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Socorro Leandro	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024

LIC9099 (FAS) - (06/04)

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