306005223-1-22-2024-22-AS-SSAS-CZYV2L-20240130150320

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005223
Report Date: 01/22/2024
Date Signed: 01/22/2024 05:03:50 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
12/13/2023 and conducted by Evaluator Kevin Saborit-Guasch

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20231213110026

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: 84	DATE:	01/22/2024
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Melanie Washington, Executive Director		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff are not assisting resident with bathing needs.

Resident was billed for services not rendered.

INVESTIGATION FINDINGS:

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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch conducted an unannounced visit to the facility for the purpose of following up on the investigation of the allegations listed above. LPA was greeted and granted entry by front desk staff after explaining the purpose of the visit. Executive Director Melanie Washington was present to assist with LPA's requests throughout the visit.

An initial complaint investigation visit took place on December 19, 2023. LPA requested and obtained records maintained at the facility for three current residents along with the December billing records for the full census and individual billing records for resident R1. One staff interview and one resident interview were conducted during the visit.

During the present visit, LPA requested the full census and reviewed four more resident records.

CONTINUED ON FORM LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2024

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 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
12/13/2023 and conducted by Evaluator Kevin Saborit-Guasch

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20231213110026

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: 84	DATE:	01/22/2024
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Melanie Washington, Executive Director		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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9

Staff did not provide resident with a copy of an admissions agreement.

INVESTIGATION FINDINGS:

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Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2024

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 4

Control Number 22-AS-20231213110026

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: SUNNYCREST SENIOR LIVING	FACILITY NUMBER: 306005223
	VISIT DATE: 01/22/2024

NARRATIVE

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CONTINUED FROM FORM LIC9099-A

Regarding the allegation that Staff did not provide resident with a copy of an admissions agreement, the following has been concluded: Based on an interview conducted with resident R1 during the initial complaint investigation visit, the request for a copy of the admission agreement effective September 12, 2023 was granted and a copy was provided to the resident which allowed a clarification regarding toileting care to take place. The allegation is therefore found to be Unfounded, meaning that the allegation is false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted and a copy of this report was provided to a facility representative.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 22-AS-20231213110026

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: SUNNYCREST SENIOR LIVING	FACILITY NUMBER: 306005223
	VISIT DATE: 01/22/2024

NARRATIVE

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CONTINUED FROM FORM LIC9099

Regarding the allegation that Staff are not assisting resident with bathing needs, the following has been concluded: Based on a review of resident R1's pre-admission assessment, physician report and admission agreement, R1 is determined to require occasional assistance from facility staff with toileting care which is confirmed by the Care Level assessment of a Level 1 appearing in the current admission agreement signed by the resident and a facility representative prior to admission. Additionally, R1 does not have any documented cognitive impairment. LPA conducted an interview with R1 during the initial complaint investigation visit during which R1 stated she had not received toileting assistance from facility staff during the first weeks of her admission. However an interview with facility staff appears to indicate R1 requested a discount after declining one of her weekly showers two weeks in a row. As a result, the allegation is found to be Unsubstantiated, meaning that although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur.

Regarding the allegation that Resident was billed for services not rendered, the following has been concluded: Based on a review of R1s billing records provided by the facility, an additional $500 for Assisted Living - Care Level 1 was assessed monthly in addition to the residence fees. R1 was stated and/or documented as having declined to be assisted for one of her weekly showers on September 28, 2023 and October 1, 2023 and requesting a discount of the care fees as a result. However, the care fees are not assessed per services rendered, and pro-rating of the fee to reflect declined showers could not be accommodated per the terms of the admission agreement. As a result, the allegation is found to be Unsubstantiated, meaning that although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted and a copy of this report along were provided to a facility representative.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2024

LIC9099 (FAS) - (06/04)

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