306004754-11-30-2023-22-AS-SSAS-CYATPX-20231207135503

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004754
Report Date: 11/30/2023
Date Signed: 11/30/2023 09:46:26 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
11/09/2020 and conducted by Evaluator Jessica Cho

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20201109104853

FACILITY NAME:	SUNFLOWER GARDENS		FACILITY NUMBER:	306004754
ADMINISTRATOR:	SANDRA ACOSTA-LOUER		FACILITY TYPE:	740
ADDRESS:	3730 S. GREENVILLE AVENUE		TELEPHONE:	(714) 641-0959
CITY:	SANTA ANA	STATE: CA	ZIP CODE:	92704
CAPACITY:	0	CENSUS: 49	DATE:	11/30/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Judith Torres- Executive Director		TIME COMPLETED:	09:50 AM

ALLEGATION(S):

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Staff failed to inform family of change in resident's condition.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jessica Cho arrived unannounced and met with Executive Director (ED) Judith Torres for the purpose of delivering the findings into the above allegation.

On November 9, 2020, the Department received the complaint. On November 17, 2020, LPA Lydia Martinez initiated the complaint investigation by telephone with then ED Sandra Acosta-Louer and obtained facility/resident records via email due to the Coronavirus 2019 precautionary measures. On September 29, 2023, LPA Jessica Cho continued the investigation with ED Judith Torres. During the visit, LPA Cho interviewed staff and obtained additional records pertaining to Resident #1 (R1). A subsequent visit was made on October 27, 2023, to obtain records and an interview. Further interviews were also conducted by telephone. The following was revealed during the course of the investigation:

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Jessica Cho	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 11/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023

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-20201109104853

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: SUNFLOWER GARDENS	FACILITY NUMBER: 306004754
	VISIT DATE: 11/30/2023

NARRATIVE

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It is alleged that the staff failed to inform the family of a change in the resident’s condition. On June 10, 2020, per the Progress Notes, an order was placed to R1’s physician requesting a swallow evaluation after R1 was observed to be exhibiting swallowing difficulties the same day. The facility’s Physician Fax Transmission/Phone Order forms reveal swallow evaluation requests were submitted to R1’s primary care physician on June 10th, 13th, 15th, and 16th of 2020. It was observed that the initial order form, on June 10th, noted R1 was “temporarily placed on a puree diet” which was also evidenced on the Progress Notes. R1 was on the puree diet from June 10th to June 16th, however there was no documented evidence of the Responsible Person (RP) being informed of the modified diet. There was no documentation on June 17th as well. Per the Progress Notes, the RP was informed on June 18, 2020, of R1 not eating or drinking and other changes. It was reported during the interview with one out of the one staff that the RP was informed of R1’s change of condition which corresponded with the Progress Notes. Due to conflicting information, LPA does not have substantial evidence to corroborate this allegation.

Therefore, based on the interviews which were conducted and the records that were reviewed, although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the following allegation: Staff failed to inform the family of a change in the resident’s condition is deemed UNSUBSTANTIATED.

An exit interview was conducted with Executive Director Judith Torres, and a copy of this report including the LIC811 were provided at the end of the visit.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Jessica Cho	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 11/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023

LIC9099 (FAS) - (06/04)

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