306005223-9-1-2022-22-AS-SSAS-CJRV84-20220930161203

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005223
Report Date: 09/01/2022
Date Signed: 09/01/2022 05:00:07 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
08/30/2022 and conducted by Evaluator Kathrina Chin

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20220830101636

FACILITY NAME:	SUNNYCREST SENIOR LIVING		FACILITY NUMBER:	306005223
ADMINISTRATOR:	SARAH CLEESEN		FACILITY TYPE:	740
ADDRESS:	1925 SUNNY CREST DRIVE		TELEPHONE:	(714) 992-1999
CITY:	FULLERTON	STATE: CA	ZIP CODE:	92835
CAPACITY:	210	CENSUS: 87	DATE:	09/01/2022
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Melanie Washington, Executive Director		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff did not ensure the facility was free from pests.

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 allegation that facility did not ensure that the facility was free from pests revealed the following:

LPA toured the facility and interviewed two kitchen staff members. Staff 1 and staff 2 stated that they have observed several roaches in the kitchen area and the bathroom near the kitchen. Both staff indicated that they have informed a reception staff of the problem. LPA interviewed Witness 1 and who stated that one roach was observed in the middle of Bistro area of the facility on August 25, 2022. LPA interviewed Staff 3 who is the Building Services Director and he stated that he has seen roaches in several resident apartments and is aware of the issue. ( Continued on LIC9099C)

Substantiated

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: 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)

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Control Number 22-AS-20220830101636

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 A 09/02/2022 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	Maintenance & Operation(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not being met as evidenced by: Based on observation, record review, and interviews,	1 2 3 4 5 6 7	Melanie Washington, Executive Director stated that a written plan of action to address the elimination of roaches from the facility. Melanie Washington stated the Building Services Director has scheduled a serivce with a licensed exterminator on 9/2/2022.
	8 9 10 11 12 13 14	Three out of three staff members interviewed have observed roaches in the facility. S1 and S2 observed roaches in the kitchen area. S3 observed roaches in several apartment units. W1 observed a roach in the Bistro area of the facility. This poses an immediate health & safety risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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 Santos	TELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina Chin	TELEPHONE: (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)

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Control Number 22-AS-20220830101636

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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S3 stated that he has sprayed some apartment units. S3 stated that Ecolab is the exterminator that services the facility and will ensure that the roach issue is addressed. S3 stated that he will contact Ecolab to come to the facility to address the roach issue on the various areas of the facility. Based on the information gathered during the investigation and review of all documents obtained, the following allegation: Staff did not ensure the facility was free from pests is 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 Santos	TELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina Chin	TELEPHONE: (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)

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