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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306003502
Report Date: 10/10/2024
Date Signed: 10/10/2024 08:57:02 AM

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
07/11/2022 and conducted by Evaluator Kimberly Lyman
COMPLAINT CONTROL NUMBER: 22-AS-20220711113234
FACILITY NAME:SUNNY CREST GUEST HOME #3FACILITY NUMBER:
306003502
ADMINISTRATOR:KENNETH/MARIA HUNTERFACILITY TYPE:
740
ADDRESS:5174 FOX HILLSTELEPHONE:
(714) 562-1082
CITY:BUENA PARKSTATE: CAZIP CODE:
90621
CAPACITY:6CENSUS: 3DATE:
10/10/2024
UNANNOUNCEDTIME BEGAN:
07:45 AM
MET WITH:Ken HunterTIME COMPLETED:
09:20 AM
ALLEGATION(S):
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Facility is not providing proper care and supervision to resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to continue the investigation into the above allegation. LPA was greeted and granted and granted entry into the facility and explained the reason for the visit.

During the course of the investigation, the department interviewed staff, witness and residents as well as reviewed and obtained pertinent documentation such as physician report. Regarding the allegation that facility is not providing proper care and supervision to resident, the investigation revealed the following: Resident 1 (R1) admitted into the facility on 03/22/2022 with a diagnosis of Mild Cognitive Impairment. Resident had noted behaviors which were discussed with family representative. Facility indicates providing care and supervision to the resident while requesting additional medical assessments from the family due to increasing behaviors and health concerns. Per facility, family refused to acknowledge concerns brought to their attention. R1 was voluntarily discharged from the facility by family. Four out of five witnesses state facility provided care and CONTINUED ON LIC 9099C DATED 10/10/2024
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 22-AS-20220711113234
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: SUNNY CREST GUEST HOME #3
FACILITY NUMBER: 306003502
VISIT DATE: 10/10/2024
NARRATIVE
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supervision to resident and was meeting the resident's needs. Based on interviews conducted, LPA is unable to corroborate the allegation. Therefore, the allegation is deemed unsubstantiated, meaning that although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted and a copy of this report was provided to facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2