306002636-3-3-2023-22-AS-SSAS-CPP3BM-20230306170634

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306002636
Report Date: 03/03/2023
Date Signed: 03/03/2023 01:43:26 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
02/02/2021 and conducted by Evaluator Michelle Reed

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20210202102021

FACILITY NAME:	SUNFLOWER LIVING		FACILITY NUMBER:	306002636
ADMINISTRATOR:	SUNITA CHAND		FACILITY TYPE:	740
ADDRESS:	9282 BLANCHE AVENUE		TELEPHONE:	(714) 534-7872
CITY:	GARDEN GROVE	STATE: CA	ZIP CODE:	92841
CAPACITY:	6	CENSUS: 5	DATE:	03/03/2023
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Sunita Chand		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Resident developed a Stage 2 pressure injury while in care.
Resident sustained unexplained bruising.
Lack of supervision of resident resulting in multiple falls.
Facility staff did not notify resident’s physician of a change in the resident’s condition.

INVESTIGATION FINDINGS:

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Licensing Program Analyst Michelle Reed arrived at the facility to deliver the findings of this complaint investigation. Upon arrival, LPA met with Staff Ryan Tanglao and Sonia Caceres. Administrator Sunita Chand arrived a short time later.The complaint was investigated and consisted of interviews with the facility staff, Administrator and a review of Resident #1’s records. The following was determined:

R1 was admitted into the facility on 1/8/18. R1 had Dementia with episodes of agitation and confusion and frequent UTI’s. R1 needed assistance with her ADL’s and the UTI’s required hospitalization and IV treatments.

On 1/7/21 R1 was hospitalized due to a UTI and returned to the facility on 1/8/21. R1 was placed on Home Health and began to receive antibiotic injections for 14 days to treat the infection.
R1 was hospitalized again on 1/25/21 due to agitation and 2/1/21 for a UTI. R1 did have bruising at the injection sites and where the IV was placed.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: Michelle Reed	TELEPHONE: (714) 743-4958
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2023

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-20210202102021

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: SUNFLOWER LIVING	FACILITY NUMBER: 306002636
	VISIT DATE: 03/03/2023

NARRATIVE

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Interviews conducted did not disclose any falls, however, R1 wandered and would not sleep. R1 was in and out of the hospital three times within the period of 1 month and the responsible party was notified and present at each visit.

Based upon a review of records and the interviews conducted the allegations are unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove the alleged violations occurred.

An exit interview was conducted and a copy of this report was provided to Sunita Chand.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: Michelle Reed	TELEPHONE: (714) 743-4958
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2023

LIC9099 (FAS) - (06/04)

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