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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005223
Report Date: 09/09/2020
Date Signed: 09/09/2020 05:02:09 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:SUNNYCREST SENIOR LIVINGFACILITY NUMBER:
306005223
ADMINISTRATOR:HEATHER YOSTFACILITY TYPE:
740
ADDRESS:1925 SUNNY CREST DRIVETELEPHONE:
(714) 992-1999
CITY:FULLERTONSTATE: CAZIP CODE:
92835
CAPACITY:210CENSUS: 89DATE:
09/09/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Heather YostTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA), Kathrina Chin contacted the facility via telephone as a follow up to a case management- incident via telephone due to COVID-19 and for pre-cautionary measures. LPA Chin identified herself and spoke to Heather Yost, Executive Director.

LPA, Kathrina Chin spoke to Heather Yost , Executive Director regarding resident #1 over the telephone today. LPA explained that the purpose of this tele-visit is to obtain information regarding the death of R1 which occurred on 9/5/2020.

It was indicated on the death report that on 9/5/2020 at around 6 PM, the police came into the community to inform them that R1 was found dead along the bridal trails behind the facility property. Heather Yost further reported that Investigator Tasse from the Coroner's Department said that there were no signs of trauma as she was on her way back from CVS as she had a CVS bag and her purse with her.

The Administrator indicated that the Coroner's Office is conducting an autopsy and will determine the cause of death. LPA Chin requested several documents of R1 such as physician's report and care plan. stated that she will provide these documents via email. Ms. Yost provided the police report number and Coroner's Report Number. Ms. Yost further explained that R1 is alert and able to leave the building assisted per her Physician's report dated 3/6/19.

No deficiency cited this review as per Title 22 of the California Code of Regulations.

An exit interview was conducted with Administrator via telephone and a copy of this report was provided to Administrator via email. Heather Yost agreed to confirm the receipt of the document, review the report and return a signed copy.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina ChinTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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