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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005223
Report Date: 03/23/2023
Date Signed: 03/23/2023 04:29:45 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
12/29/2022 and conducted by Evaluator Patricia Velazquez
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20221229121814
FACILITY NAME:SUNNYCREST SENIOR LIVINGFACILITY NUMBER:
306005223
ADMINISTRATOR:MELANIE WASHINGTONFACILITY TYPE:
740
ADDRESS:1925 SUNNY CREST DRIVETELEPHONE:
(714) 992-1999
CITY:FULLERTONSTATE: CAZIP CODE:
92835
CAPACITY:210CENSUS: 80DATE:
03/23/2023
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Melanie Washington - Executive DirectorTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Facility kitchen equipment is in disrepair

INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Patricia Velazquez conducted a subsequent complaint visit to deliver the findings of the investigation into the above allegations. LPA Velazquez was allowed entry into the facility and met with Business Office Director (BOD) Gail Blessum and explained the purpose of the visit. Executive Director (ED) Melanie Washington arrived shortly after LPA's arrival to assist with the visit.

On today's visit LPA Velazquez conducted interviews with resident and staff. LPA also reviewed and requested copies of facility and resident records. During the course of the investigation the following was revealed: LPA Velazquez reviewed and obtained copies of facility and resident records. LPA also conducted interviews with residents and staff. The records reviewed included a copy of the Direct Supply Products and Services Agreement dated December 16, 2022 for the purchase of a double convection oven, and a Clark Food Service Equipment invoice dated December 22, 2022 for the purchase of an ice machine. Two of two staff interviewed confirmed that as of this date, the double convection oven has yet to arrive at the facility. Resident records
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (713) 334-2062
LICENSING EVALUATOR NAME: Patricia VelazquezTELEPHONE: (949) 236-0556
LICENSING EVALUATOR SIGNATURE:

DATE: 03/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2023
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 5
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-20221229121814

FACILITY NAME:SUNNYCREST SENIOR LIVINGFACILITY NUMBER:
306005223
ADMINISTRATOR:MELANIE WASHINGTONFACILITY TYPE:
740
ADDRESS:1925 SUNNY CREST DRIVETELEPHONE:
(714) 992-1999
CITY:FULLERTONSTATE: CAZIP CODE:
92835
CAPACITY:210CENSUS: 80DATE:
03/23/2023
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Melanie Washington - Executive DirectorTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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9
Facility does not ensure food is of good quality is provided to residents
Facility is not kept properly cleaned
Staff do not ensure residents are accorded a safe, secure environment while in care
Licensee is not properly answering residents' communications
Facility does not have sufficient quantity of snacks
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Patricia Velazquez conducted a subsequent complaint visit to deliver the findings of the investigation into the above allegations. LPA Velazquez was allowed entry into the facility and initially met with Business Office Manager (BOM) Gail Blessum and LPA explained the purpose of the visit. Executive Director (ED) Melanie Washington arrived shortly after LPA's arrival to assist with the visit.

On today's visit LPA Velazquez conducted interviews with resident and staff. LPA also reviewed and requested copies of facility and resident records. During the course of the investigation the following was revealed: LPA Velazquez reviewed and obtained copies of facility and resident records. The records reviewed included facility meal menus dated December 2022 - March 2023 and a Dietary Services Consultation Report dated May 11, 2022. Per dietary staff the next dietary consultation with a Registered Dietician is scheduled for April 4, 2023. The resident records reviewed included Physician's Reports and Sunnycrest Level of Care Assessments CA.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (713) 334-2062
LICENSING EVALUATOR NAME: Patricia VelazquezTELEPHONE: (949) 236-0556
LICENSING EVALUATOR SIGNATURE:

DATE: 03/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 22-AS-20221229121814
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: 03/23/2023
NARRATIVE
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At 10:13 AM LPA Velazquez along with ED Washington conducted a tour of the facility's Bistro Cafe where a variety of snacks were available such as yogurt, pudding, granola bars, cereal, apples, oranges, hot chocolate, tea, and coffee. The coffee machine currently cannot dispense regular coffee only decaffeinated but regular coffee is available in the dining room. Per ED Washington the snacks are replenished at least twice a day, once in the morning and again at 3 PM. Five of six individuals interviewed indicated there is one specific resident who on occasion takes an extensive amount of snacks back to their room. The facility is working to address this matter. At 10:21 AM LPA Velazquez along with ED Washington conducted a tour of the kitchen where lunch was being prepared. LPA Velazquez along with the cook observed a sufficient quantity of perishable and non-perishable supply of food present. The cook stated they speak to the residents during mealtimes to ensure residents are happy with the quality of the food served.

Throughout the investigation LPA Velazquez observed the common areas of the facility to be clean and well-maintained as were the resident rooms LPA observed. Six of six individuals interviewed provided conflicting statements and could not corroborate the any of the five aforementioned allegations. Four of six individuals interviewed felt safe and felt they were accorded a safe and secure environment while in care. Five of six individuals interviewed indicated the food served was of good quality with a variety of menu options to select from. Four of six individuals interviewed indicated they did not have any issue with the facility's response to their request for assistance via their call buttons. Throughout the investigation LPA Velazquez and ED Washington toured the exterior of the facility with the exit doors leading to the exterior of the facility were observed to be locked from the outside where no one can gain access into the facility except through the main entrance.

Based on the observations made by LPA Patricia Velazquez, interviews which were conducted and the records that were reviewed, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the following allegations: Facility does not ensure food is of good quality is provided to residents, Facility is not kept properly cleaned, Staff do not ensure residents are accorded a safe, secure environment while in care, Licensee is not properly answering residents' communications, and Facility does not have sufficient quantity of snacks are deemed UNSUBSTANTIATED. An exit interview was conducted with Executive Director Melanie Washington. A copy of the report was signed by ED Washington but due to technical difficulties LPA Velazquez was not able to print the report. ED Washington agrees to receive the report via email.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (713) 334-2062
LICENSING EVALUATOR NAME: Patricia VelazquezTELEPHONE: (949) 236-0556
LICENSING EVALUATOR SIGNATURE:

DATE: 03/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 22-AS-20221229121814
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: 03/23/2023
NARRATIVE
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reviewed included Physician's Reports and Sunnycrest Level of Care Assessments CA.

At 10:21 AM LPA Velazquez along with ED Washington conducted a tour of the kitchen where lunch was being prepared. ED Washington showed LPA Velazquez the new ice maker that was purchased by the facility and it was also confirmed with a copy of the invoice provided to LPA. Throughout the investigation LPA Velazquez observed the common areas of the facility to be clean and well-maintained as were the resident rooms LPA observed.

Based on the observations made by LPA Patricia Velazquez, interviews which were conducted and the records that were reviewed, the preponderance of evidence standard has been met, therefore the following allegation: Facility kitchen equipment is in disrepair is deemed SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8 is/are being cited on the attached LIC 9099D.

An exit interview was conducted with Executive Director Melanie Washington. A copy of the report was signed by ED Washington but due to technical difficulties LPA Velazquez was not able to print the report. ED Washington agrees to receive the report along with the Appeal Rights, and LIC 9098 via email.

SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (713) 334-2062
LICENSING EVALUATOR NAME: Patricia VelazquezTELEPHONE: (949) 236-0556
LICENSING EVALUATOR SIGNATURE:

DATE: 03/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 22-AS-20221229121814
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: 03/23/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/07/2023
Section Cited
CCR
87555(b)(32)
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General Food Service Requirements. The following food service requirements shall apply: Equipment or appropriate size and type shall be provided for the storage, preparation and service of food and for sanitizing utensils and tableware, and shall be well maintained.
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Licensee to ensure all equipment is maintained at all times. Licensee to provide LPA with written documentation indicating the convection has been received by POC due date.
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This requirement is not met as evidenced by: based on observation & interview the licensee did not maintain specific kitchen equipment in good repair. This poses a potential risk to the health and safety of 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: (713) 334-2062
LICENSING EVALUATOR NAME: Patricia VelazquezTELEPHONE: (949) 236-0556
LICENSING EVALUATOR SIGNATURE:

DATE: 03/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5