306005223-1-29-2024-22-AS-SSAS-CZYVCV-20240130151946

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005223
Report Date: 01/29/2024
Date Signed: 01/29/2024 02:03:21 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
01/22/2024 and conducted by Evaluator Kevin Saborit-Guasch

COMPLAINT CONTROL NUMBER: 22-AS-20240122111856

FACILITY NAME:	SUNNYCREST SENIOR LIVING		FACILITY NUMBER:	306005223
ADMINISTRATOR:	AGUIRRE, MONICA		FACILITY TYPE:	740
ADDRESS:	1925 SUNNY CREST DRIVE		TELEPHONE:	(714) 992-1999
CITY:	FULLERTON	STATE: CA	ZIP CODE:	92835
CAPACITY:	210	CENSUS: 84	DATE:	01/29/2024
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Melanie Washington, Executive Director		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident's room is in disrepair

Facility is not adhering to the admission agreement

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of initiating the investigation into the allegations listed above. LPA was greeted and granted entry by Executive Director Melanie Washington after stating the purpose of the visit and listing the allegations.

LPA accompanied with administrator conducted a survey of the room resident R1 is admitted to. Water temperature along with operation for the two wall heater units in the room were verified. A resident interview with R1 was conducted along with a staff interview with the facility's executive director and business services manager. The current admission agreement for R1 was requested and reviewed.

Regarding the allegation that Resident's room is in disrepair, the following has been concluded: During the tour of the physical plant conducted, LPA verified the operation for the thermostatic faucet in the shower.
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: 01/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2024

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 2

Control Number 22-AS-20240122111856

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: 01/29/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

CONTINUED FROM LIC9099-C
The water from the shower was measured at a maximum temperature of 117F. The temperature adjustment was observed to be functional, ranging from cold water on the left to the hottest setting on the right, with accurate stops in each direction. During R1's interview, it was stated that the water could change from cold to scalding without the temperature setting being modified, however LPA was unable to replicate this after monitoring the temperature for approximately five minutes. The two HVAC units observed in the dining room and the bedroom were both verified to be functional. Both units turn on, can be placed in Hot/Cold/Energy Saving/Fan only modes, blow hot and cold depending on the settings used and the target temperature set onto the unit. R1 stated that the living room unit had been replaced recently, as evidenced by the presence of plastic wrapping alongside the wall outlet. Based on these observations, the allegation is found to be Unsubstantiated, meaning that although the allegation may have happened or are valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred.

Regarding the allegation that Facility is not adhering to the admission agreement, the following has been concluded: LPA reviewed the agreement to include the following statement "You will receive a monthly statement that itemizes any fees or charges that you have incurred". LPA requested documentation of the statements sent to R1's responsible party. Monthly statements were historically emailed to the resident's responsible party with the exception of the most recent month during which staff stated that it should have been mailed out. Email records dated prior to December 18, 2023 are no longer accessible due to a change of management. Upon review it was determined that the address on file used in late December 2023 may have been outdated. The facility does not keep any logs of outgoing mail, and could therefore not provide evidence. Facility staff is currently working on the upcoming billing cycle for February and will return to emailed invoices. As a result, the allegation is found to be Unsubstantiated, meaning that although the allegation may have happened or are valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred.

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: 01/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2