306005223-9-29-2022-22-AS-SSAS-CKD2U3-20221019174136

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005223
Report Date: 09/29/2022
Date Signed: 09/29/2022 03:15:39 PM

Unsubstantiated

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
12/09/2021 and conducted by Evaluator Kathrina Chin

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20211209094403

FACILITY NAME:	SUNNYCREST SENIOR LIVING		FACILITY NUMBER:	306005223
ADMINISTRATOR:	HEATHER YOST		FACILITY TYPE:	740
ADDRESS:	1925 SUNNY CREST DRIVE		TELEPHONE:	(714) 992-1999
CITY:	FULLERTON	STATE: CA	ZIP CODE:	92835
CAPACITY:	210	CENSUS: 75	DATE:	09/29/2022
		UNANNOUNCED	TIME BEGAN:	03:15 PM
MET WITH:	Melanie Washington, Executive Director		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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1) Staff does not respond to resident call button.
2) Staff does not adequately assist the resident with showering.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Kathrina Chin conducted an unannounced visit for the purpose of delivering the findings on a complaint investigation. LPA met with Melanie Washington, Executive Director.

During the investigation of the above allegations, LPA interviewed staff, witnesses as well as reviewed and obtained pertinent records.

The investigation revealed that resident (R1) fell on the floor and sustained a laceration on her head on December 8, 2021. Facility staff dialed 911 emergency personnel and resident was taken to the hospital. LPA interviewed R1 who stated that staff responded to the call button when she fell on December 8, 2021. She further explained that she had pneumonia and was confused when she was admitted to the hospital after the fall. R1 further explained that she was independent last year and can bathe and shower herself. (Continued on LIC 9099c)

Unsubstantiated

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: 09/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2022

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-20211209094403

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: 09/29/2022

NARRATIVE

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R1's Needs and Services Plan indicated that R1 is independent and does not require any assistance from in showering, dressing and toileting. R1 also self administers her own medications. R1 is independent and does not require any assistance from staff for any of her care.

Based on the information gathered during the investigation and review of all documents obtained, the following allegations: Staff does not respond to resident call button and Staff does not adequately assist the resident with showering are deemed Unsubstantiated.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated.

An exit interview was conducted, appeal rights explained and provided. A copy of this report was provided during the visit to Melanie Washington, Executive Director.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina Chin	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2022

LIC9099 (FAS) - (06/04)

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