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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005223
Report Date: 09/22/2022
Date Signed: 09/23/2022 04:41:53 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
11/23/2021 and conducted by Evaluator Kathrina Chin
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20211123111937
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: 75DATE:
09/22/2022
UNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Melanie Washington, Executive DirectorTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Lack of care and supervision resulting in resident falling.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Kathrina Chin made an unannounced visit to the facility for the purpose of a complaint investigation. LPA met with Executive Director, Melanie Washington. The investigation consisted of interviews with the facility Administrator, and reviewing and obtaining documentation. R1 was also interviewed. The following was determined:

Resident 1 (R1) fell on November 9, 2021 and struck the back of her head on the end of her bed frame. It was reported that R1 fell three times the same day. Facility staff called 911 emergency personnel. Resident was sent out to UCI Medical Center. Prior to admission, resident came from a skilled nursing facility due to a fall. Resident 1 was interviewed and R1 explained that she fell a few times on due to weakness and balance issues. R1 explained that staff immediately called 911 emergency personnel after her fall. (Continued on LIC 9099C)
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina ChinTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2022
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 2
Control Number 22-AS-20211123111937
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: 09/22/2022
NARRATIVE
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LPA, Kathrina Chin interviewed Stephanie Guerrero, Resident Care Coordinator, Jessica Thielmann, Resident Care Director and Julie Sanchez, Activities Director.

Resident returned to the facility using a wheelchair on or about November 23, 2021. Resident was placed on hospice upon her return due to a heart condition and had a 1:1 caregiver.

Based on the above findings, this allegation is determined to be UNFOUNDED. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.

An exit interview was conducted and appeal rights explained, and a copy of this report was given to Melanie Washington, Executive Director.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina ChinTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2