306005223-3-23-2023-22-AS-SSAS-CQE23N-20230329170236

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005223
Report Date: 03/23/2023
Date Signed: 03/23/2023 04:10:37 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
07/28/2022 and conducted by Evaluator Patricia Velazquez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20220728130902

FACILITY NAME:	SUNNYCREST SENIOR LIVING		FACILITY NUMBER:	306005223
ADMINISTRATOR:	SARAH CLEESEN		FACILITY TYPE:	740
ADDRESS:	1925 SUNNY CREST DRIVE		TELEPHONE:	(714) 992-1999
CITY:	FULLERTON	STATE: CA	ZIP CODE:	92835
CAPACITY:	210	CENSUS: 80	DATE:	03/23/2023
		UNANNOUNCED	TIME BEGAN:	01:01 PM
MET WITH:	Melanie Washington - Executive Direct		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff mismanaged resident's medication
Staff did not provide a safe environment for resident in care
Resident suffered from dehydration while in care
Resident's room is unkempt

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 Executive Director (ED) Melanie Washington and explained the purpose of the visit.

On today's visit LPA Velazquez conducted interviews with residents and staff. LPA also reviewed and obtained copies of facility and resident records. During the course of the investigation the following was revealed: LPA conducted interviews with residents and staff. The records reviewed included Resident Physician's Reports, Preplacement Appraisal Information, Sunnycrest Senior Living Level of Care Assessments, Medication Lists, and Medication Administration Records. Nine of nine individuals interviewed provided conflicting statements and could not corroborate any of the above allegations. Two of two individuals interviewed stated the family of Resident (R) #1 requested R1's medication and vitamin supplements be administered in a different manner that

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: 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)

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Control Number 22-AS-20220728130902

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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conflicted with the written physician's orders. Facility staff indicated that written physician's orders were required prior to changing the manner in which R1 could receive their medication and vitamin supplements.

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. Four of six individuals interviewed felt safe and felt they were accorded a safe and secure environment while in care. Six of six individuals interviewed stated fluids are provided to residents throughout the day for their consumption. Four of four individuals interviewed stated that no resident has suffered dehydration while in care and further indicated all residents are provided with fluids throughout the day but that it was up to the resident to drink the fluids and stay hydrated. These four individuals stated all residents are encouraged to stay hydrated throughout the day when checking in the residents and they ensure fluids are readily available and easily accessible to residents. Four of four individuals stated R1's room was always clean and orderly.

Based on the observations made by LPA 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: Staff mismanaged resident's medication, Staff did not provide a safe environment for resident in care, Resident suffered from dehydration while in care, and Resident's room is unkempt are all 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 at the time of the visit. ED Washington agrees to receive the report via email along with the LIC 811.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (713) 334-2062
LICENSING EVALUATOR NAME: Patricia Velazquez	TELEPHONE: (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)

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