198603294-11-14-2024-11-AS-RORN-DBNPY5-20241205104323

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603294
Report Date: 08/07/2024
Date Signed: 11/14/2024 10:41:17 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, 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
07/30/2024 and conducted by Evaluator Antonine Richard

COMPLAINT CONTROL NUMBER: 11-AS-20240730163126

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: 60	DATE:	08/07/2024
		UNANNOUNCED	TIME BEGAN:	08:24 AM
MET WITH:	Sylvia Guevara		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Staff did not safeguard resident's personal belongings.

INVESTIGATION FINDINGS:

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The original LIC9099 and LIC9099C dated 08/07/2024, are being amended. The revised LIC9099 and LIC9099C dated 11/14/2024. The amendment does not change the findings of this investigation.
On 08/07/2024, Licensing Program Analyst (LPA) Antonine Richard, initiated a complaint investigation regarding the allegation listed above. LPA meet with Business Office Sylvia Guevara and the purpose of the visit was explained.

The investigation consisted of the following: During today’s investigation LPA, and Business Office conducted a tour of the Main Building. and LPA interviewed 6 out of 60 clients and one staff #1 (1) Business Office, and the Administrator #1 (A1). C1 was not present at the facility and was not able to provide an interview. LPA reviewed client (C1) and collected C1 records.

Continue to LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 11/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024

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-20240730163126

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: 08/07/2024

NARRATIVE

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Allegation: Staff did not safeguard the president’s personal belongings.

It is alleged staff did not safeguard residents’ belongings which resulted in the Client (C1) missing a TV, clothes, a VCR, and a prosthetic leg. Interviews indicated that C1 was admitted at St Francis Medical Center on 11/08/2023. The department interviewed Administrator/Mary Montiano (A1), who stated she called the hospital for updates; however, the hospital would not release information to her. A1 stated that after C1’s hospitalization, she was unable to obtain a status for C1, and when C1 was discharged. C1 made no contact with the facility after being hospitalized until 02/06/2024. A1 received a call from C1 who stated, they would not be returning to the facility. C1 would not share where they were living when A1 received the call. A1 stated she reviewed the personal property policy in C1’s Admission Agreement with C1 during this call. This policy states upon moving out, the client will retrieve their belonging within 10 days. C1 stated they would send a family member to pick up C1’s personal belongings; however, C1 did not have a family retrieve their belongings and C1 made no arrangements to retrieve their belongings.

A1 stated in July of 2024, C1 called and asked to pick up their personal belongings. A1 explained that the facility removed C1’s personal belongings per the facility's Admission Agreement policy. The department was unable to contact C1 due to the phone numbers on record not being valid.

Continued LIC9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 11/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20240730163126

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: 08/07/2024

NARRATIVE

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Continued LIC9099-C

The department reviewed the client’s Admission Agreement. The Admission Agreement clearly states that 10 days after the date of discharge/transfer, the residents are responsible for retrieving their personal belongings and if they are unable to retrieve their belongings after 10 days the facility is no longer responsible and will discard the belongings. The Admission Agreement states after 10 days, the facility will not be responsible for storing them. The department interviewed five (5) Clients (C2-C6) 5 out of 5 stated the facility safeguards their property and the facility provides keys to them to lock their doors when they are not present at the facility. 5 out of 5 Clients expressed no issues with their personal property being lost, missing, or stolen.

Based on interviewed and records reviewed, there is insufficient evidence to support the allegation that staff did not safeguard resident's personal belongings. 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.

No deficiencies cited. Exit interview conducted and a copy of the report was provided to the business Office Sylvia Guevara

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 11/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024

LIC9099 (FAS) - (06/04)

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