306003418-6-16-2022-22-AS-MVAO-CFVTVU-20220630150432

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306003418
Report Date: 06/16/2022
Date Signed: 06/16/2022 03:40:10 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
11/17/2020 and conducted by Evaluator Lydia Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20201117104622

FACILITY NAME:	SUNSHINE HOME CARE		FACILITY NUMBER:	306003418
ADMINISTRATOR:	ESTER DELA CRUZ		FACILITY TYPE:	740
ADDRESS:	2428 WEST AVENUE		TELEPHONE:	(714) 525-1566
CITY:	FULLERTON	STATE: CA	ZIP CODE:	92833
CAPACITY:	6	CENSUS: 5	DATE:	06/16/2022
		UNANNOUNCED	TIME BEGAN:	02:50 PM
MET WITH:	Ester DeLa Cruz		TIME COMPLETED:	03:50 PM

ALLEGATION(S):

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Staff neglect resident resulting in pressure wound
Facility staff failed to provide activities for residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Lydia Martinez conducted an unannounced visit to deliver findings on above allegations. LPA met with Administrator (AD) Ester DeLa Cruz and purpose of visit was discussed.

Allegation of staff neglects resident resulting in pressure wound was investigated and the following was found: The investigation consisted of interviews with AD, residents and documentation reviewed such as Physician’s Reports, Communication logs, and Hospice notes. Based on information obtained, no specific one resident was identified when the complaint was filed. Review of records of residents who lived at facility from 09/2020 to 04/2022, LPA was unable to identify the resident who staff allegedly neglected resulting in pressure wounds. Interview with Resident 1 (R1) reported R1 has lived at facility since 2018 and denied the the allegation. R1’s stated bed sores come and go because R1 hardly gets out of bed by choice, but sores never go untreated. R1 stated staff is good and keep sores clean and dry and also has a wound specialist who comes out. Interview with R3 stated sores are on heals and are treated by a Nurse who visits weekly. R3 stated staff are good on keeping R3 dry and clean. Therefore, allegation is Unsubstantiated.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Lydia Martinez	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022

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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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
11/17/2020 and conducted by Evaluator Lydia Martinez

COMPLAINT CONTROL NUMBER: 22-AS-20201117104622

FACILITY NAME:	SUNSHINE HOME CARE		FACILITY NUMBER:	306003418
ADMINISTRATOR:	ESTER DELA CRUZ		FACILITY TYPE:	740
ADDRESS:	2428 WEST AVENUE		TELEPHONE:	(714) 525-1566
CITY:	FULLERTON	STATE: CA	ZIP CODE:	92833
CAPACITY:	6	CENSUS:	DATE:	06/16/2022
		UNANNOUNCED	TIME BEGAN:	02:50 PM
MET WITH:	Ester DeLa Cruz		TIME COMPLETED:	03:50 PM

ALLEGATION(S):

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* Staff yell at residents
* Residents left in soiled diapers
* Untrained staff giving medication
* Residents are fed rotten food

INVESTIGATION FINDINGS:

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Based on observation and interviews conducted, residents in care are hard of hearing. LPA interviewed Resident (R3) and Resident 4 (R4) and LPA had to speak loud as residents stated they could not hear LPA. Due to their condition, LPA observed staff members needed to speak loud to communicate with the residents. R1 stated R1 hears staff speak loud to R4 because R4 can not hear. R1 denied staff yell at them. Therefore, allegation that Staff yell at residents is Unfounded

Based on LPA's observations and interviews conducted, it was determined that residents are not being left in soiled diapers. Interview with AD reported residents are changed every 2-3 hours or sooner if necessary. This was corroborated through interviews with R1 and R3 who stated they are changed way too often and even sometimes when not needed. Both R1 and R3 stated they are always dry and clean. Therefore, allegation that residents left in soiled diapers is Unfounded.

(cont. LIC9099C)

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Lydia Martinez	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 22-AS-20201117104622

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: SUNSHINE HOME CARE	FACILITY NUMBER: 306003418
	VISIT DATE: 06/16/2022

NARRATIVE

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LPA conducted interviews with Residents and staff. Residents (R1, R3 and R4) interviewed stated they receive their medication from Ester who is the owner. They stated their medication is given on time and had no complaints. LPA reviewed medication logs and training records for staff. Staff had received the required training, including Medication training, per regulations. Therefore, allegation that Untrained staff are giving medication is Unfounded.

It was alleged that residents are fed rotten food. LPA inspected the kitchen on 11/24/2020 via Facetime, on 04/07/2022 and on today’s date during on-site visits. LPA observed food to meet the 7-day non perishable and 2-day perishable requirement. LPA did not observe any rotten food. Per R1, R3 and R4, the food is good. During the visit on 4/7/2022, LPA observed lunch being served. Lunch consisted of Pizza, spaghetti with ground beef, veggies and vegetable soup. A cup of fruit and juice were also served on the side. On today's date, LPA observed dinner being made and consisted of vegetable soup, chicken Alfredo, and fish soup. Therefore, allegation that residents are fed rotten food is Unfounded.

This agency has investigated the complaint. We have found that the above allegations were Unfounded, meaning that the allegations were false, could not have happened and/or are without reasonable bases. We have therefore dismissed the complaint.

LPA Martinez conducted an exit interview with AD DeLa Cruz and copy of this report was emailed during today's visit.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Lydia Martinez	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20201117104622

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: SUNSHINE HOME CARE	FACILITY NUMBER: 306003418
	VISIT DATE: 06/16/2022

NARRATIVE

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Based on interview with Administrator, only 1 of the 4 residents is interested in participating in activities such as Karaoke as the one Resident loves to sing. LPA observed Resident 4 (R4) happy and singing loud in front of the TV. AD stated that back in 11/2020 facility had 3 of 5 residents who were on Hospice and did not care to participate in activities. R1 told LPA during the interview, R1 is always invited to participate but would rather play games on cell phone, read or listen to other residents sing because that’s what R1 likes to do. AD stated she suggest other activities such as exercise while sitting down watching TV in the living room, play bingo, play board games but residents refuse. AD stated she can not force the residents to participate. AD stated staff attempt to exercise the residents in the morning while in bed. LPA was unable to determine if the allegation occurred as reported. Therefore, allegation is Unsubstantiated.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Lydia Martinez	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022

LIC9099 (FAS) - (06/04)

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