306005223-1-4-2023-22-AS-LADS-CN9NJG-20230120093020

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005223
Report Date: 01/04/2023
Date Signed: 01/04/2023 03:34:10 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
12/29/2022 and conducted by Evaluator Patricia Velazquez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20221229150112

FACILITY NAME:	SUNNYCREST SENIOR LIVING		FACILITY NUMBER:	306005223
ADMINISTRATOR:	MELANIE WASHINGTON		FACILITY TYPE:	740
ADDRESS:	1925 SUNNY CREST DRIVE		TELEPHONE:	(714) 992-1999
CITY:	FULLERTON	STATE: CA	ZIP CODE:	92835
CAPACITY:	210	CENSUS: 79	DATE:	01/04/2023
		UNANNOUNCED	TIME BEGAN:	11:40 AM
MET WITH:	Melanie Washington - Executive Director		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Facility did not properly notify resident of a rate increase

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Patricia Velazquez conducted an unannounced initial 10 day complaint visit to investigate the above allegation. LPA Velazquez was allowed entry into the facility and met with Executive Director (ED) Melanie Washington and explained the purpose of the visit.

On today's visit LPA Velazquez conducted interviews with residents and ED Washington and reviewed facility and resident records. During the course of the investigation the following was revealed: LPA Velazquez reviewed facility and resident records. Records reviewed included admission agreements, resident level of care assessments with service agreements, physician's reports, and Preplacement Appraisals. Per ED Washington the facility utilizes a level of care system that incorporates a point system. ED further stated the facility conducts a level of care assessment on each resident biannually or when there is a change of condition. Based

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (713) 334-2062
LICENSING EVALUATOR NAME: Patricia Velazquez	TELEPHONE: (949) 236-0556
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2023

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-20221229150112

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: 01/04/2023

NARRATIVE

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on the results of the level of care assessment, a point value is assessed. The point value then translates to a particular level of care which results in the monthly care fees the facility assesses each resident. The facility has levels of care ranging from Level 1 to Level 8. LPA Velazquez also reviewed Resident (R) #1's hospice records. R1's responsible party was provided two statements with an invoice due date of 01/01/2023. One invoice indicated the amount due as $7803.25 and another invoice with a total amount due of $6003.25. ED Washington stated the facility notified R1's responsible party that the facility was waiving the additional charges for the increase of level of care services as R1's responsible party indicated they had not been properly notified of the increase in fees due to the increase in the level of care R1 required. Facility records indicated R1 had a level of care assessment on February 19, 2022 and again on October 21, 2022 with facility records indicating R1's responsible party was notified of the level of care when each assessment was conducted. LPA Velazquez also reviewed email communication between the complainant and the facility with one email dated October 21, 2022 from Resident Care Director Judi Williams notifying R1 that R1's level of care had increased to a Level 5. The interviews conducted revealed conflicting statements and the allegation could not be corroborated.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the following allegation: Facility did not properly notify resident of a rate increase is deemed UNSUBSTANTIATED.

An exit interview was conducted with Executive Director Melanie Washington and a copy of this report along with the LIC 811 was provided at the time of this visit.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (713) 334-2062
LICENSING EVALUATOR NAME: Patricia Velazquez	TELEPHONE: (949) 236-0556
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2023

LIC9099 (FAS) - (06/04)

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