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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005223
Report Date: 09/01/2022
Date Signed: 09/01/2022 05:10:59 PM

Substantiated


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
08/26/2022 and conducted by Evaluator Kathrina Chin
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20220826102143
FACILITY NAME:SUNNYCREST SENIOR LIVINGFACILITY NUMBER:
306005223
ADMINISTRATOR:SARAH CLEESENFACILITY TYPE:
740
ADDRESS:1925 SUNNY CREST DRIVETELEPHONE:
(714) 992-1999
CITY:FULLERTONSTATE: CAZIP CODE:
92835
CAPACITY:210CENSUS: 87DATE:
09/01/2022
UNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Melanie Washington, Executive DirectorTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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1) Facility did not have a working telephone on the premises.
2) Back entrance to the facility was unlocked at night.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kathrina Chin made an unannounced visit to investigate the above complaint allegation. LPA identified herself and discussed the purpose of the visit with Executive Director, Melanie Washington. LPA interviewed several staff members, and one witness.

The investigation into the allegations that the facility did not have a working telephone on the premises and back entrance to the faciity was unlocked and open at night are the following:

Melanie Washington, Executive Director was interviewed and stated that the facility phones are cordless and a staff forgot to charge the telephones on August 25, 2022. Witness 1(W1) tried calling the facility on the evening of August 25, 2022 and no staff answered the telephones. The telephones were not working as the staff had forgotten to charge the telephones. (Continued on LIC 9099C)
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina ChinTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022
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 3
Control Number 22-AS-20220826102143
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: SUNNYCREST SENIOR LIVING
FACILITY NUMBER: 306005223
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/01/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/02/2022
Section Cited
CCR
87311
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Telephones- All facilities shall have telephone service on the premises. This requirement is not being met as evidenced by: Based on observation, record review, and interviews,
Melanie Washington, Executive Director was interviewed and stated that the facility phones are cordless and a staff forgot to charge the telephones on August 25, 2022.
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Melanie Washington, Executive Director will submit a plan of correction and that staff will receive in-service training.
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Witness 1 tried calling the facility on the evening of August 25, 2022 and no staff answered. This poses an immediate health & safety risk to residents in care
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Type B
09/02/2022
Section Cited
CCR
87468.1(a)
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Peronal Right of Residents in all Facilities- To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.
This requirement is not being met as evidenced by: Based on observation, record review, and interviews,
Melanie Washington, Executive Director admitted that the facility back entrance unlocked and was propped open on the evening of August 25, 2022.
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Melanie Washington, Executive Director stated that an in-service training regarding the community safety after hours will be conducted by next week.
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Witness 1 visited the facility on the evening of August 25, 2022 at 11:50 PM and the back entrance was unlocked and propped open by a rock. This poses an immediate health & safety risk to residents in care
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina ChinTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20220826102143
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: SUNNYCREST SENIOR LIVING
FACILITY NUMBER: 306005223
VISIT DATE: 09/01/2022
NARRATIVE
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On the same night, Melanie Washington, Executive Director was interviewed and stated that the facility back entrance was propped open by a rock on August 25, 2022. Witness 1 visited the facility on August 25, 2022 around 11:50 PM and observed the back entrance wedged open with a rock.


Based on the information gathered during the investigation and review of all documents obtained, the following allegations: Facility did not have a working telephone on the premises. Back entrance to the facility was unlocked at night are substantiated.

Based on LPA's observations and conducted interviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

The following deficiencies are cited today as per Title 22, Division 6, of the California Code of Regulations.
An exit interview was conducted along with appeal rights were provided and a copy of this report was left.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina ChinTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3