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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005223
Report Date: 10/13/2022
Date Signed: 10/13/2022 03:54:03 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
02/28/2022 and conducted by Evaluator Kathrina Chin
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20220228144922
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: 78DATE:
10/13/2022
UNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Melanie Washington, Executive Director TIME COMPLETED:
04:30 PM
ALLEGATION(S):
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1) Resident sustained multiple injuries while in care.
2) Resident is left in wheelchair.
3) Staff handled resident roughly.
4) Staff did not assist resident with incontinence needs.
5) Facility did not have enough staff to care for resident.
6) Staff did not clean resident's room and bathroom.
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 identified herself and discussed the purpose of the visit with Executive Director, Melanie Washington. LPA interviewed staff members, residents and other witnesses and reviewed pertinent documents.

The investigation revealed the following:

R1 is a 93 year old who has resided at the facility since September 1, 2021. R1 is wheelchair bound and requires assistance for all transfers. R1 requires a two person lift. R1 requires the highest level of care (Level 6) for care and assistance according to R1’s admission agreement. R1 has been diagnosed with right side weakness, and Parkinson’s Disease. R1 had in recent years a hip fracture, multiple strokes and heart attacks. (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: 10/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2022
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 6
Control Number 22-AS-20220228144922
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: 10/13/2022
NARRATIVE
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R1 sustained three skin tears as a result of staff improperly caring for R1. The Resident Care Director/LVN(S1) explained on how R1 sustained the three skin tears. On December 2021, R1 sustained a laceration on her left forearm when staff wheeled her into the dining room. The staff did not lift her arms before sliding her under the table causing skin on her arm to come off. On January 29, 2022, R1 got a large skin tear on her leg because one staff pulled R1 from her wheelchair to R1’s bed and her foot got caught at the end of the bed. R1’s leg bled so much that R1 was sent to the hospital and received four (4) stitches. On February 28, 2022, R1 sustained a skin tear on her elbow on the bathroom vanity while in the bathroom with a caregiver. R1 stated that facility staff are rough when handling her during transfers and during showers.


R1 and W1 reported that the Resident Care Director/LVN(S1) at the time stated that the skin tear sustained on January 20, 2022 resulted from an agency caregiver. S1 further stated to R1 and W1 that they do not always have sufficient staff to provide the two-person lift that R1 requires. S1 and S2 were interviewed and both indicated that the facility lacks staff on certain days.

According to the R1’s admission agreement, resident is paying for the highest level of care to live at the facility. R1 requires incontinent care, transfers to the dining room for meals, dressing and showers. W1 stated that R1 is left on the wheelchair often because she is a two person lift and they would leave in the wheelchair after bringing her up from the dining room. R1 sustained a Stage I pressure injury and home health agency for care. W1 stated that R1 is supposed to get regular checks from staff every two to three hours but was not receiving them. W1 stated that R1’s incontinent care has not been changed regularly every two to three hours or as needed.

Staff would leave R1's diapers in the trash can and it was uncovered. The room smelled like urine. W1 stated R1’s room and bathroom are not cleaned regularly. On February 28, 2022, R1 sustained a skin tear on her elbow which resulted in bleeding. There was no staff who cleaned up the blood on the bathroom floor and vanity. The facility Administrator stated that the facility does not have any housekeepers for many months.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina ChinTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 22-AS-20220228144922
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: 10/13/2022
NARRATIVE
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Based upon review of records and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be Substantiated.

See LIC 9099D for cited deficiencies 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: 10/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 22-AS-20220228144922
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: 10/13/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/14/2022
Section Cited
CCR
87411(a)
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 Facility personnel shall at all time be sufficient in numbers, and competent to provide the services necessary to meet residents needs. This requirement is not being met as evidenced by: Based on record review and interviews, staff failed to demonstrate competency in which R1 sustained three skin tears due to improper care and transfer from staff
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Administrator stated that she will submit proof of correction to CCL by 10/14/2022.
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on December 2021, January 29, 2022 and February 28, 2022. R1 was roughly handled by staff. Facility staff did not have sufficient caregivers for R1's transfers. R1 was often left in the wheelchair after coming back from the dining room as R1 requires a two person staff. This poses an immediate risk to the residents in care.
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Type A
10/14/2022
Section Cited
CCR
87464(f)(1)
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 Basic Services shall at a minimum include:(1) care and supervision as defined in Section 87101(c)(3) and Health and Safety Code Section 1569.2(c). This regulation was not met as evidence by: Licensee did not ensure that adequate care and supervision was provided to R1 as evidenced by that R1 did not receive
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Administrator stated that she will submit proof of correction to CCL by 10/14/2022.
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regular incontinent care and proper showers. Staff forgot to bring R1 to a breakfast meal. This poses a potential risk to the resident 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: 10/13/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 6
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
02/28/2022 and conducted by Evaluator Kathrina Chin
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20220228144922

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: 78DATE:
10/13/2022
UNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Melanie Washington, Executive Director TIME COMPLETED:
04:30 PM
ALLEGATION(S):
1
2
3
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5
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9
 Staff did not feed the resident.
INVESTIGATION FINDINGS:
1
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3
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5
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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 identified herself and discussed the purpose of the visit with Executive Director, Melanie Washington. LPA interviewed staff members, residents and other witnesses and reviewed pertinent documents.

Witness 1 stated that facility staff forgot to bring R1 downstairs to the dining room one Saturday for breakfast on February 2022. However, facility staff brought breakfast to R1’s room. 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, appeal rights explained and provided. A copy of this report was provided during the visit to Melanie Washington, Executive Director.
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: 10/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 22-AS-20220228144922
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: 10/13/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/20/2022
Section Cited
CCR
87303(a)
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Maintenance and 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 interviews and records,
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Administrator stated that she will submit proof of correction to CCL by 10/20/2022.
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R1's apartment unit not cleaned on February 22, 2022. This poses a potential risk to the 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: 10/13/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2022
LIC9099 (FAS) - (06/04)
Page: 6 of 6