306002568-4-3-2024-22-AS-AJLO-D4GMU5-20240419095435

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306002568
Report Date: 04/03/2024
Date Signed: 04/03/2024 04:02:46 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/29/2024 and conducted by Evaluator Ruth Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20240329162449

FACILITY NAME:	SUNRISE AT YORBA LINDA		FACILITY NUMBER:	306002568
ADMINISTRATOR:	MARIA DOMINGO		FACILITY TYPE:	740
ADDRESS:	4792 LAKEVIEW AVE		TELEPHONE:	(714) 693-5368
CITY:	YORBA LINDA	STATE: CA	ZIP CODE:	92886
CAPACITY:	93	CENSUS: 75	DATE:	04/03/2024
		UNANNOUNCED	TIME BEGAN:	01:20 PM
MET WITH:	Tyler Hawks, Executive Director		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff prevent reident from making/receiving phone calls.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ruth Martinez made an unannounced visit to conduct the required 10-day visit to begin the investigation into the allegation listed above. LPA arrived at the facility was greeted by receptionist and granted entry. LPA met with Tyler Hawk, Executive Director and explained the nature of today’s visit.
Findings are based upon this investigation which included a tour of the physical plant of the facility and interviews conducted. It is alleged that staff prevent resident from making/receiving phone calls. Interviews conducted with 6 of 6 residents indicated that they make phone calls from their own personal cell phones, or they can use the facility phones. Residents stated that they get assistance with phone calls when they need it and they have never had an issue with not being able to make calls. Residents indicated that if they can’t get call on their personal cell phone that family member call the front desk to be able to talk to them. Interview with 1 of 1 witness stated that they are aware that assistance is provided to resident R1if they

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (949) 430-1222
LICENSING EVALUATOR NAME: Ruth Martinez	TELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:	DATE: 04/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2024

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 22-AS-20240329162449

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: SUNRISE AT YORBA LINDA	FACILITY NUMBER: 306002568
	VISIT DATE: 04/03/2024

NARRATIVE

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need to make a phone call. Witness indicated that they have received calls from R1 when R1 needs to speak to them. Witness indicated that they are not sure how R1 makes the call if assisted or not but none the less they have received calls from R1 from their personal cell phone. Interviews with 2 of 2 staff indicated that R1 at times presses pendent to call for assistance and ask the staff to dial the numbers to make calls. Staff indicated that if R1 request not to receive calls or to speak to a caller that staff do not force R1 to speak to the caller. Staff indicated that there are times when R1 does not want to talk to anyone and makes that very clear to staff and staff indicated that R1 has that right to refuse calls. LPA toured the physical plant of the facility and observed R1 on their cell phone making a call and a care staff was in their room with them.

Based on the information mentioned above, the Department is unable to ascertain if the allegation occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed Unsubstantiated.

An exit interview was conducted with the Executive Director and a copy of this LIC9099 report was left at facility.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (949) 430-1222
LICENSING EVALUATOR NAME: Ruth Martinez	TELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:	DATE: 04/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2024

LIC9099 (FAS) - (06/04)

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