198603294-12-15-2023-11-AS-MVAO-CZ524L-20240102160408

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603294
Report Date: 12/13/2023
Date Signed: 12/15/2023 11:48:34 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
08/03/2023 and conducted by Evaluator Pamela Bunker

COMPLAINT CONTROL NUMBER: 11-AS-20230803134639

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: 49	DATE:	12/13/2023
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Juan Cruz and Jennifer Serrano		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Staff are prohibiting resident from having visits

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced complaint visit on Wednesday, December 13, 2023. Upon arrival at the facility. LPA Bunker called the facility via telephone and conducted a Risk Assessment. Based on the assessment, the facility is cleared of COVID-19 infection. LPA Bunker met with Assistant Administrator Juan Cruz and Caregiver Supervisor Jennifer Serrano. LPA Bunker explained the purpose of today's visit.

The investigation consisted of the following: Interviews with staff members S1, S2, S3, and S4, along with residents R2 through R7. Resident R1, who was also a subject of this inquiry, had vacated the premises on July 17, 2023, and therefore was not available for an interview. LPA Bunker requested and reviewed residents' records. LPA Bunker asked questions relevant to the nature of the complaint. Allegation: Staff prohibited the resident from having visits. Staff members S1, S2, S3, and S4, as well as residents R2 through R7, unanimously reported that the facility does not impose restrictions on the residents' rights to have visitors. See continued LIC812-C page 2

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023

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 3

Control Number 11-AS-20230803134639

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: 12/13/2023

NARRATIVE

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Continued LIC812-C page 2

S1, S2, S3, and S4, as well as residents R2 through R7, affirmed that residents are permitted to receive and actively engage in telephone conversations using the facility's phone. In the event of incoming calls for residents, the staff members are responsible for ensuring that the call is promptly relayed to the respective resident. Regarding Resident R1's situation, staff members S1, S2, S3, and S4 disclosed that R1 had expressed a preference for not communicating with his family, outside agencies, or representatives. Staff stated that R1 has personal rights. The staff also confirmed their awareness of the whereabouts of all residents within the facility. S1, S2, S3, and S4 stated on the date of July 17, 2023, it was reported and documented that Resident R1 was admitted to St. Francis Hospital for medical attention and did not return to the facility due to the necessity of a higher level of care. LPA Bunker requested copies of supporting documents.

Investigation revealed the following: Interviews conducted with staff members (S1-S4) and residents (R2-R7) confirmed that residents are not restricted from having visitors at Sunshine Assisted Living. S1-S4 verified the relocation of Resident R1 and are aware of his placement and current whereabouts. S1-S4 and R2-R7 stated the facility encourages residents to sign in and out when leaving the premises. S1-S4 disclosed that R1 was hospitalized at St. Francis Hospital for seizures and subsequently transferred to a nursing home for a higher level of care. It was confirmed by staff that R1 did not receive any funds from the Central Valley Regional Center while in placement. S1-S4 refuted any refusal to provide information to the Central Valley Regional Center, stating that all inquiries from the Central Valley Regional Center were adequately addressed. Regarding communication with his family and the Regional Center, R1 consistently declined to engage, often refusing to come to the phone or respond to messages. S1-S4 emphasized that residents' personal rights are respected, including their choice not to engage in telephone conversations. The facility maintains thorough documentation of resident records, accessible to the Regional Center for information about R1's care. The facility stated that they have not received payments from the Central Valley Regional Center, and the facility is not a vendor to the Regional Center, as confirmed by S1. There has been no refusal to allow the Regional Center to communicate with R1, nor is there any intention by the facility to seek conservatorship for R1. S1-S4 clarified that R1 is not diagnosed with dementia and categorically denied the allegation made against them.

See continued LIC812-C page 3

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20230803134639

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: 12/13/2023

NARRATIVE

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Continued LIC812-C page 3

Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient evidence to support the 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 deemed unsubstantiated.

A copy of the Complaint Investigation Report LIC9099 & LIC9099-C, was provided to staff. There were no deficiencies cited. An exit interview was conducted.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023

LIC9099 (FAS) - (06/04)

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