306004790-4-22-2022-22-AS-AJLO-CLUVX4-20221206154855

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004790
Report Date: 04/22/2022
Date Signed: 04/22/2022 05:05:09 PM

Unfounded

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
05/11/2021 and conducted by Evaluator Shobhana Frank

COMPLAINT CONTROL NUMBER: 22-AS-20210511164300

FACILITY NAME:	ROSSMOOR SUNSHINE VILLA-KENSINGTON		FACILITY NUMBER:	306004790
ADMINISTRATOR:	RICARDO BANOS		FACILITY TYPE:	740
ADDRESS:	11802 KENSINGTON RD.		TELEPHONE:	(562) 794-9047
CITY:	ROSSMOOR	STATE: CA	ZIP CODE:	90720
CAPACITY:	6	CENSUS: 6	DATE:	04/22/2022
		UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Administrator, Minnie Resurreccion		TIME COMPLETED:	03:05 PM

ALLEGATION(S):

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Personal Rights
Medication

INVESTIGATION FINDINGS:

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This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Shobhana Frank for the purpose of delivering findings for the investigation into the above identified complaint allegations. LPA met with Administrator, Minnie Resurreccion and explained the reason for today’s inspection. On 5/20/2021, 10 day visit was conducted by Valarie Cook
During the course of investigation LPA Shobhana Frank conducted interview at facility with Licensee/Administrator, S 1, S 2, reviewed facility Medication Administration Medication Record (MAR) all staff schedules for all facilities (Foster, Kensington, Wembley, Oak Way, and Ruth Elaine). LPA toured the facility, resident rooms and observed medication locked in cabinet near dining area.

The investigation into allegations that Administrator is touching the residents inappropriately during visits, revealed following.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Shobhana Frank	TELEPHONE: (714) 293-8294
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022

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-20210511164300

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: ROSSMOOR SUNSHINE VILLA-KENSINGTON	FACILITY NUMBER: 306004790
	VISIT DATE: 04/22/2022

NARRATIVE

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LPA interviewed Administrator (AD 1) he explained his role at the facility to be primarily as administrative. He denied being involved with any resident care. he does not provide care.
He denied having any personnel issues with any of the staff. AD 1 adamantly denied ever touching or being inappropriate with any resident or staff. He added that he has always treated everyone as a professional. S1 Stated she has worked for company 20 years and is familiar with AD 1. S 2 stated she has Worked for Six years. Both staff stated that Administrator don’t interact with them and Never seen him being inappropriate with anyone. S1 and s 2 stated that they calls for house maintenance, payroll issues but doesn't stat long and doesn't get involved with any of the residents. S1 and S 2 denied having knowledge of any staff working at all 5 houses. S1 and S2 stated that AD 1 is quiet and available if needed. AD 2 reported handling all staff schedules for all facilities (Foster, Kensington, Wembley, Oak Way, and Ruth Elaine) She denied employing a staff that floats between all five facilities) She admitted that facilities have relief staff that might work three days a week but they work specifically at one or two facilities but not all five. AD 2 reported handling all staff schedules for all facilities (Foster, Kensington, Wembley, Oak Way, and Ruth Elaine)
She denied employing a staff that floats between all five facilities) She admitted that facilities have relief staff that might work three days a week but they work specifically at one or two facilities but not all five.

The investigation into allegations of 1) Facility not following medications as prescribed, 2) Medications are not locked and 3) Medications that are the same are being shared among residents, revealed the following:
LPA Frank inspected all resident rooms and medications storage during visit. LPA observed each resident room clean and clear of any medication.
Medication was observed to centrally stored, locked and separated by resident name and picture. medication records reflect all pertaining medication was dispensed accordingly. LPA reviewed centrally stored medication logs, medication records and copy of scabies medication prescription for all involved residents. LPA noted any and all medication dispensed to appropriate resident.

Based on reviews of documents, interviews and observation We have found that the complaint allegations are unfounded, meaning that the allegation was false, could not have happened and/or is without reasonable basis. Therefore, the allegations are deemed UNFOUNDED, meaning the allegations are false, could not have happened and/or is without a reasonable basis.
An exit interview was conducted with facility representative and a copy of this report provided

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Shobhana Frank	TELEPHONE: (714) 293-8294
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022

LIC9099 (FAS) - (06/04)

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