306004595-3-30-2022-22-AS-AORZ-CD8MVN-20220406095659

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004595
Report Date: 03/24/2022
Date Signed: 03/30/2022 11:49:34 AM

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
03/17/2022 and conducted by Evaluator Kathrina Chin

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20220317113408

FACILITY NAME:	SUNRISE ASSISTED LIVING OF FULLERTON		FACILITY NUMBER:	306004595
ADMINISTRATOR:	CHRISTIAN OTBO		FACILITY TYPE:	740
ADDRESS:	2226 N EUCLID ST		TELEPHONE:	(714) 738-3656
CITY:	FULLERTON	STATE: CA	ZIP CODE:	92835
CAPACITY:	85	CENSUS: 67	DATE:	03/24/2022
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Cynthia Bui, Business Office Manager		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Facility did not issue a refund to resident.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs), Kathrina Chin and Edward Tapia made an unannounced visit to the facility for the purpose of a complaint investigation.

Upon arrival, LPAs met with Cynthia Bui, Business Office Coordinator and explained the above allegation. Ms. Bui provided copies of the invoices of Resident 1 ( R1). Ms. Bui stated that the R 1 received a refund for the move- in fee and the fee for one to one private duty aid totaling in the amount of $1343.00. The refund consisted of a move-in fee of $400 and the fee for 1:1 private duty aid of $943. Resident 1 has received the refund in full.

(Continued on LIC 9099C)

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina Chin	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022

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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Control Number 22-AS-20220317113408

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 ASSISTED LIVING OF FULLERTON	FACILITY NUMBER: 306004595
	VISIT DATE: 03/24/2022

NARRATIVE

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This agency has investigated the complaint and is determined to be UNFOUNDED. We have found that the complaint was unfounded, meaning that 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, appeal rights explained and a copy of this report was given to Cynthia Bui, Business Office Coordinator.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina Chin	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022

LIC9099 (FAS) - (06/04)

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