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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603294
Report Date: 11/16/2023
Date Signed: 11/16/2023 03:47:13 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
11/08/2023 and conducted by Evaluator Mario Leon
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20231108135030
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: 68DATE:
11/16/2023
UNANNOUNCEDTIME BEGAN:
09:29 AM
MET WITH:Mary Jane Montiano, Administrator TIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff spoke inappropriately to resident
INVESTIGATION FINDINGS:
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On 11/16/23 Licensing Program Analyst (LPA) Mario Leon conducted an initial, unanounced, complaint visit at the above mentioned facility. LPA was met by Mary Jane Montiano, Administrator (S1), and both S1 and LPA toured the facility.

The investigation consisted of the following:
On 11/16/23 LPA requested and reviewed facility documents and toured the facility inside and out. LPA interviewed six (6) out of sixty-eight (68) residents and six (6) out of twenty-four (24) staff.

The investigation revealed the following:
Regarding the allegation: "Staff spoke inappropriately to resident". It has been alleged that staff members have used multiple types of foul language, resulting in the loss of residents' dignity. LPA interviewed 6 residents (R1-R6). Four (4) out of 6 residents have denied the allegation. One (1) resident denied the interview with LPA. Report continues, see LIC9099C.
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023
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-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: 11/16/2023
NARRATIVE
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LPA interviewed 6 staff (S1-S6). 6 out of 6 staff members do not agree with the allegation. All staff agree that in-staff training have prepared them to properly deal with behaviors presented to them by the residents who live at the above-mentioned facility.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated.

An exit interview was conducted with Mary Jane Montiano, Administrator (S1), and a copy of this report has been provided.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2