306002644-4-5-2022-22-AS-AORZ-CMCVLC-20221222153140

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306002644
Report Date: 04/05/2022
Date Signed: 04/05/2022 02:09:44 PM

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
10/26/2021 and conducted by Evaluator Rosie Quiroz

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20211026112550

FACILITY NAME:	SUNRISE OF MISSION VIEJO		FACILITY NUMBER:	306002644
ADMINISTRATOR:	PSENECNIK, ROXANNE		FACILITY TYPE:	740
ADDRESS:	26151 COUNTY CLUB DR		TELEPHONE:	(949) 582-2010
CITY:	MISSION VIEJO	STATE: CA	ZIP CODE:	92691
CAPACITY:	110	CENSUS: 84	DATE:	04/05/2022
		UNANNOUNCED	TIME BEGAN:	01:36 PM
MET WITH:	Lucy Yi, Business Office Coordinator, Patti Darsow, Director of Sales and Roxanne Psenicnik, Executive Director		TIME COMPLETED:	02:14 PM

ALLEGATION(S):

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-Residents sustained unexplained bruising while in care

INVESTIGATION FINDINGS:

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On today’s date, Licensing Program Analyst (LPA) Rosie Quiroz conducted an unannounced visit to conclude this agency’s investigation into the complaint allegation mentioned above. LPA Rosie Quiroz arrived to the facility and was COVID-19 screened and met with Business Office Director Lucy Yi. Director of Sales Patty Darsow joined the inspection tour on or about 10:18am. Executive Director Roxanne Psenicnik arrived on or about 10:47am.
During the pre investigation telephone call, Interviewee indicated requesting to remove allegation “Residents sustained unexplained bruising while in care.” Interviewee indicated not making that allegation.
This agency has found the complaint allegation of " Residents sustained unexplained bruising while in care” is deemed UNFOUNDED; Meaning that the allegation was false, could not have happened or is without a reasonable basis. We have therefore dismissed the complaint allegation listed above.
An exit interview was conducted with Executive Director Roxanne Psenicnik and a copy of this report was provided via email.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie Quiroz	TELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2022

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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