198603294-2-8-2024-11-AS-UCOL-D2QQYT-20240223113539

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603294
Report Date: 02/08/2024
Date Signed: 02/08/2024 04:54:10 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
02/02/2024 and conducted by Evaluator Socorro Leandro

COMPLAINT CONTROL NUMBER: 11-AS-20240202142538

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: 56	DATE:	02/08/2024
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Mary Jane Montiano - Administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff are mismanaging resident's medication
Staff are not providing resident with transportation to appointments
Staff are not meeting resident's needs
Staff are not providing resident with appropriate furnishing accommodations
Staff did not make resident's call button accessible

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Socorro Leandro conducted an unannounced complaint visit on 02/08/2024 around 8:00 AM. LPA explained the purpose of the visit and was accompanied by the Administrator Jane Montiano inside and outside the facility during this inspection.

The investigation consisted of the following: Request of Facility Documents & Review of Documents, Facility Inspection specifically in the Medication Room and Client Bedrooms, Interviews with Staff and Clients. LPA reviewed 5 client files specifically their Admission Agreement, Appraisal/Needs and Services Plan, Personal Rights, Physicians Report, Medication Administration Record (MAR), Centrally Stored Medication and Destruction Report. Furthermore, LPA reviewed documents: Residents Showers, Client Roster, Staff Roster/Schedule, Transportation Services, Resident Shower Slips, and Driver Weekly Vehicle Inspection Report. The investigation consisted of 7 client interviews and 5 staff interviews which included a Cook, Caregiver, Medical Technician, Administrator, and Driver.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024

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-20240202142538

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: 02/08/2024

NARRATIVE

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The investigation revealed the following:

Regarding the allegation “Staff are mismanaging resident's medication,” that clients are not sure if staff will refill their medication and staff do not provide clients with their pain medication. The investigation revealed that there are no discrepancies with the medication administration. Record reviews of Medical Administration Record and observation of medicine containers demonstrates that there are no discrepancies in medication administration. Interviews conducted indicated the following: 6 out 7 client interviews showed that clients are satisfied with the medication administration.

Regarding the allegation “Staff are not providing resident with transportation to appointments,” that facility does not assist with transportation, or have staff members accompany clients to their appointments. The investigation revealed that the facility does assist with transportation and if necessary, staff accompanies clients to their appointments. LPA observed a facility van and facility pick up and drop off location. Record reviews of Driver Weekly Vehicle Inspection reports for the month of February 2024 indicated that facility transports clients to their appointments and bank as well as stays with them throughout their outing. Interviews conducted indicate the following: 4 out of 5 employee interviews indicated that there is a facility van, facility provides transportation, and a staff member stays with the client if necessary, and 6 out of 7 client interviews indicated that facility provides transportation.

Regarding the allegation “Staff are not meeting resident's needs,” that staff are not allowing residents to eat in their room. The investigation revealed that the facility does allows clients to eat in their rooms if they are sick or unable to go to the dinning hall. Interviews conducted indicated the following: 5 out of 7 client interviews indicated that clients can eat in their bedrooms if they are sick, and 5 out 5 staff interviews indicated that clients are able to eat in their bedrooms if clients are sick or unable to go to the dinning hall.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20240202142538

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: 02/08/2024

NARRATIVE

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Regarding the allegation “Staff are not providing resident with appropriate furnishing accommodations,” that there is not enough space for residents clothing items and that furniture is in disrepair. The investigation revealed that facility does provide sufficient furniture for residents clothing and furniture is in good repair. LPA inspected over 10 client bedrooms and observed furniture in good repair and that there is sufficient closet/drawer space for residents clothing items. Interviews conducted indicated the following: 6 out of 7 clients indicated that there is enough space in their drawers/closets for their clothing items and 1 out 7 client interviews indicated that they received a new piece of furniture within a week of their request.

Regarding the allegation “Staff did not make resident's call button accessible,” that the call button is inaccessible to clients. The investigation revealed that call buttons are accessible to clients and are in good repair. LPA inspected over 10 bedrooms and found that call buttons are accessible to clients, are in good repair, and once pressed facility staff answers in less than a minute. Interviews conducted indicated the following: 2 out of 7 client interviews indicated that they have used the call button and a staff member has assisted them.

Regarding the allegations “Staff are mismanaging resident's medication; Staff are not providing resident with transportation to appointments; Staff are not meeting resident's needs; Staff are not providing resident with appropriate furnishing accommodations; Staff did not make resident's call button accessible” the allegations may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred, therefore the allegations are unsubstantiated.

There were no deficiencies cited based on LPA observation, interviews conducted and record review in accordance with the California Code of Regulations, Title 22.

An exit interview was conducted, and a copy of this report was provided to the administrator.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024

LIC9099 (FAS) - (06/04)

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