306002636-6-13-2023-22-AS-AORZ-CSULZN-20230616091212

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306002636
Report Date: 06/13/2023
Date Signed: 06/13/2023 11:27:05 AM

Unfounded

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
06/12/2023 and conducted by Evaluator Joseph Alejandre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230612180837

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: 6	DATE:	06/13/2023
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Mundeep Shinmar		TIME COMPLETED:	11:41 AM

ALLEGATION(S):

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Resident was admitted to the facility by unauthorized individual.
The facility did not follow visitor policy.
Facility failed to provide care and supervision to a dementia resident resulting in elopement.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required 10-day visit to begin the investigation into the allegations listed above. LPA met with Administrator Mundeep Shinmar and explained the reason for the visit. LPA interviewed staff. LPA reviewed facility files and resident records. The investigation into the allegation, resident was admitted to the facility by unauthorized individual revealed the following. The Administrator reported that all of the residents at the facility were placed by their family. The Administrator reported that he is unaware of anyone not acting on good faith on behalf of his residents. A review of the resident rosters going back to 11/11/22 show that the individual named in the complaint, Prospective Resident 1 (PR1) was never a resident at the facility. The Administrator reported that PR1 was never admitted to the facility. A review of the resident roster and resident files shows that a total of 12 residents have resided at the facility since 11/11/22. None of the residents were/are PR1. The Administrator reported that on 5/19/23 they received a contract to place PR1 at the facility but they could not agree on terms with the party placing PR1. The Administrator reported that on 5/24/23 he rejected the contract.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023

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-20230612180837

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: 06/13/2023

NARRATIVE

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Based on the evidence gathered the allegation, resident was admitted to the facility by unauthorized individual is deemed unfounded, meaning the allegation is false could not have happened and/or is without a reasonable basis.

Regarding the allegation, the facility did not follow visitor policy, the investigation revealed the following. LPA interviewed 3 out of the 6 residents at the facility. 3 of the residents were unavailable for interviews. 3 out of 3 residents interviewed reported having visitors regularly and had no issues with visitation. Staff reported that residents receive visitors regularly. The Administrator reported that visitors are always welcome and there have been no complaints regarding visitation. Based on the evidence gathered the allegation, the facility did not follow visitor policy is deemed unfounded, meaning the allegation is false could not have happened and/or is without a reasonable basis.

Regarding the allegation, facility failed to provide care and supervision to a dementia resident resulting in elopement, the investigation revealed the following. It was reported that PR1 eloped from the facility. The Administrator and staff reported that none of the residents have left the facility unassisted. Staff reported that they have gone on walks with some of the residents but none of the residents have eloped or been left unattended. The Administrator and staff reported that PR1 was never at the facility. A review of facility files and resident records verifies that PR1 was never a resident at the facility. Based on the evidence gathered the allegation, facility failed to provide care and supervision to a dementia resident resulting in elopement, is deemed unfounded, meaning the allegation is false could not have happened and/or is without a reasonable basis.

An exit interview was conducted and a copy of the report provided.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023

LIC9099 (FAS) - (06/04)

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