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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004564
Report Date: 06/11/2020
Date Signed: 06/11/2020 02:59:56 PM



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
05/15/2020 and conducted by Evaluator Jenifer Tirre
COMPLAINT CONTROL NUMBER: 22-AS-20200515165257
FACILITY NAME:SUNRISE OF HUNTINGTON BEACHFACILITY NUMBER:
306004564
ADMINISTRATOR:MENSAH, ERICFACILITY TYPE:
740
ADDRESS:7401 & 7351 YORKTOWN AVETELEPHONE:
(714) 536-3032
CITY:HUNTINGTONSTATE: CAZIP CODE:
92648
CAPACITY:142CENSUS: 106DATE:
06/11/2020
UNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Jasbir Govender, Business Office CoordinatorTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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staff not meeting resident(s) needs
INVESTIGATION FINDINGS:
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Licensing Program Analyst's (LPA's) Jenifer Tirre and Kimberly Lyman contacted the facility via telephone to deliver findings on a complaint investigation via telephone due to COVID-19 and pre-cautionary measures. LPA's identified themselves and discussed the purpose of the call and the elements of the allegation with Business Office Coordinator Jasbir Govender.

During the investigation, LPA’s Jenifer Tirre and Tricia Danielson interviewed staff as well as toured the facility via Face Time. Regarding the allegation staff not meeting resident(s) needs, the investigation revealed the following: Resident 1’s (R1) Care Plan indicated resident is bathed in bed due to a medical condition. LPA’s interview with R1 revealed that R1 participated in the development of their plan of care. Record review also indicated R1’s bathing needs are regularly met and documented. R1 stated that their bathing needs had been met. LPA interviewed 3 staff. Interview had revealed that 3 out of 3 staff have diligently tested other bathing methods and found that a bed bath was the safest regarding R1’s condition.
CONT ON LIC 9099C DATED 6/11/2020
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Jenifer TirreTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2020
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-20200515165257
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: SUNRISE OF HUNTINGTON BEACH
FACILITY NUMBER: 306004564
VISIT DATE: 06/11/2020
NARRATIVE
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This agency has investigated the complaint alleging staff not meeting resident(s) needs. We have found that the complaint was unfounded, meaning the allegation was false, could not have happened and /or is without a reasonable basis. We have therefore dismissed the complaint. An exit interview was conducted with Business Office Coordinator Jasbir Govender and a copy of this report along with LIC 811-Confidential Names list was provided.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Jenifer TirreTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 2