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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005223
Report Date: 04/27/2023
Date Signed: 04/27/2023 04:47:49 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
09/13/2022 and conducted by Evaluator Patricia Velazquez
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20220913103835
FACILITY NAME:SUNNYCREST SENIOR LIVINGFACILITY NUMBER:
306005223
ADMINISTRATOR:SARAH CLEESENFACILITY TYPE:
740
ADDRESS:1925 SUNNY CREST DRIVETELEPHONE:
(714) 992-1999
CITY:FULLERTONSTATE: CAZIP CODE:
92835
CAPACITY:210CENSUS: 82DATE:
04/27/2023
UNANNOUNCEDTIME BEGAN:
12:54 PM
MET WITH:Melanie Washington - Executive DirectorTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Facility director was impaired while at the facility
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Patricia Velazquez conducted an unannounced subsequent complaint visit to deliver the findings of the investigation into the above allegation. LPA Velazquez was allowed entry into the facility and met with Executive Director Melanie Washington and explained the purpose of the visit.

On today's visit LPA Velazquez conducted interviews with residents and staff. During the course of the investigation the following was revealed: LPA Velazquez conducted interviews with residents and staff. LPA Velazquez also reviewed and obtained copies of facility, resident, and staff records. The records reviewed included Resident (R) #1's Providence St. Jude Medical After Visit Summary, R1's West Anaheim Extended Care medical records, Resident Physician's Reports, Admissions Agreement, and personnel records for Staff (S) #1. Four of nine individuals interviewed confirmed S1 smelled of alcohol and displayed slurred speech while on the job. S1 is no longer employed by the facility.
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: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023
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
09/13/2022 and conducted by Evaluator Patricia Velazquez
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20220913103835

FACILITY NAME:SUNNYCREST SENIOR LIVINGFACILITY NUMBER:
306005223
ADMINISTRATOR:SARAH CLEESENFACILITY TYPE:
740
ADDRESS:1925 SUNNY CREST DRIVETELEPHONE:
(714) 992-1999
CITY:FULLERTONSTATE: CAZIP CODE:
92835
CAPACITY:210CENSUS: 82DATE:
04/27/2023
UNANNOUNCEDTIME BEGAN:
12:54 PM
MET WITH:Melanie Washington - Executive DirectorTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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9
Facility director does not treat residents with respect and politeness
Residents are made to wait an excessive amount of time to be served meals
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Patricia Velazquez conducted an unannounced 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 Melanie Washington.

On today's visit LPA Velazquez conducted interviews with residents and staff. During the course of the investigation the following was revealed: LPA Velazquez conducted interviews with residents and staff. LPA Velazquez also reviewed and obtained copies of facility, resident, and staff records. The records reviewed included Resident (R) #1's Providence St. Jude Medical After Visit Summary, R1's West Anaheim Extended Care medical records, Resident Physician's Reports, Admissions Agreement, and personnel records for Staff (S) #1. Nine of nine individuals interviewed provided conflicting statements and could not corroborate the above allegations. Four of nine individuals interviewed indicated residents previously had to wait longer periods of time for their food to be served but that this has greatly improved more recently. Three of four individuals
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: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023
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-20220913103835
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: 04/27/2023
NARRATIVE
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interviewed did not have a problem with how long it takes to have their meals served. Seven of nine individuals interviewed felt the current director of the facility treats everyone with respect and politeness especially the residents.

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 director does not treat residents with respect and politeness and Residents are made to wait an excessive amount of time to be served meals are deemed UNSUBSTANTIATED.


An exit interview was conducted with Executive Director Melanie Washington and a copy of this report was provided at the time of this visit.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (713) 334-2062
LICENSING EVALUATOR NAME: Patricia VelazquezTELEPHONE: (949) 236-0556
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 22-AS-20220913103835
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: 04/27/2023
NARRATIVE
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Based on LPA's observations, interviews which were conducted and the records that were reviewed, the preponderance of evidence standard has been met, therefore the following allegation: Facility director was impaired while at the facility 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 and a copy of this report along with the appeal rights, LIC 811s, and LIC 9098 were provided at the time of this visit.

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

DATE: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 22-AS-20220913103835
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: 04/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/05/2023
Section Cited
CCR
87405(d)(5)
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Administrator Qualifications and Duties. The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7)...shall apply. Good character and a continuing reputation of personal integrity. This requirement is not met as
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Licensee to ensure the Administrator present is of good character and integrity at all times.
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evidenced by: based on interview and record review the Licensee did not ensure ADMIN was of good character as they were under the influence of alcohol while working. This poses a potential risk to the health & safety of residents in care.
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Licensee to submit a written statement to LPA indicating how they intend to adhere to this regulation at all times by POC due date.
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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: 04/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5