306005223-12-20-2023-22-AS-MVAO-CZY2MX-20240129163152

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005223
Report Date: 12/20/2023
Date Signed: 12/20/2023 04:10:57 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
09/11/2023 and conducted by Evaluator Jessica Cho

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230911142552

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: 91	DATE:	12/20/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Melanie Washington- Executive Director		TIME COMPLETED:	04:20 PM

ALLEGATION(S):

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Staff did not seek medical attention for resident in a timely manner.
Staff mismanaged resident's medication.
Staff did not provide a safe and comfortable environment for resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jessica Cho arrived unannounced and met with Executive Director Melanie Washington for the purpose of delivering the findings into the above allegations. LPA explained the reason for the visit and reviewed the allegations.

On September 21, 2023, LPA initiated the 10-day complaint investigation for the complaint received on September 11, 2023. During the course of the investigation, LPA interviewed residents/staff and obtained pertinent documentation. The investigation revealed the following:

It is alleged that the staff did not seek medical attention for the resident in a timely manner. Per review of the Progress Notes dated February 3, 2021 to September 23, 2023, there was no incident documenting a skin tear to the left arm that Resident #1 (R1) allegedly sustained from their dog on or before August 28, 2023. Three out of the four staff were not aware of the incident while one out of the four staff confirmed treating the resident however was unable to recall the details.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Jessica Cho	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2023

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

Control Number 22-AS-20230911142552

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: 12/20/2023

NARRATIVE

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Two out of the three residents indicated that the facility staff responds to their request in a timely manner, therefore LPA lacks sufficient information to corroborate the allegation.

It is alleged that the staff mismanaged the resident’s medication. R1 joined the medication management program effective May 31, 2023, as noted on the Progress Notes. Per interviews conducted, four out of the four staff did not corroborate with the allegation. One out of the three residents that were interviewed indicated that the Medication Technicians (MTs) stand and watch to ensure that the medication is taken while two out of the three residents indicated that they are not participants in the medication management which was verified on the Physician’s Reports.

It is alleged that the staff did not provide a safe and comfortable environment for the resident. Two out of the two staff indicated that Staff #1 (S1) maintains an open-door policy and welcomes residents and families to communicate their concerns. Only one out of the three residents interviewed was able to identify the position of S1 while two out of the three residents expressed that they did not have an interaction with S1.

Based on the 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 did not seek medical attention for resident in a timely manner, Staff mismanaged resident’s medication, and Staff did not provide a safe and comfortable environment for resident are deemed UNSUBSTANTIATED.

An exit interview was conducted with Executive Director Melanie Washington, and a copy of this report including the LIC9099-C and LIC811s were provided at the end of the visit.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Jessica Cho	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2023

LIC9099 (FAS) - (06/04)

Page: 2 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
09/11/2023 and conducted by Evaluator Jessica Cho

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230911142552

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: 91	DATE:	12/20/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Melanie Washington- Executive Director		TIME COMPLETED:	04:20 PM

ALLEGATION(S):

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Facility is in disrepair.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jessica Cho arrived unannounced and met with Executive Director Melanie Washington for the purpose of delivering the findings into the above allegation. LPA explained the reason for the visit and reviewed the allegation.

On September 21, 2023, LPA initiated the 10-day complaint investigation for the complaint received on September 11, 2023. During the course of the investigation, LPA interviewed residents/staff and obtained pertinent documentation. The investigation revealed the following:

It is alleged that the facility is in disrepair. Per inspection of the indoor and outdoor area of Resident #1’s (R1's) unit, LPA observed the following at the time of inspection on September 21, 2023: LPA observed that there were no debris and/or sand found in the tap water. The living room floor was sturdy beneath the area of the coffee table. The backyard patio ground is uneven/unstable and therefore may potentially be a safety risk to R1 as R1 utilizes a wheelchair or walker.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Jessica Cho	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 22-AS-20230911142552

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: 12/20/2023

NARRATIVE

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Therefore, based on LPA's observations and interview, the preponderance of evidence standard has been met, therefore the following allegation: Facility is in disrepair is deemed SUBSTANTIATED. The California Code of Regulations, Title 22, Division 6, Chapter 8 is being cited on the attached LIC 9099D.

An exit interview was conducted with Executive Director Melanie Washington, and a copy of this report including the LIC9099-C, LIC9099-D, LIC811, and the appeal rights were provided at the end of visit.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Jessica Cho	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 22-AS-20230911142552

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: 12/20/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 12/27/2023 Section Cited CCR 87307(d)(4)	1 2 3 4 5 6 7	87307 Personal Accommodations and Services (d) The following space and safety provisions shall apply to all facilities: (4) Stairways, inclines, ramps and open porches and areas of potential hazard to residents with poor balance or eyesight shall be made inaccessible to residents unless equipped with sturdy hand railings and unless well-lighted. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	The Executive Director stated that a handrail and/or the patio grounds would be leveled and the POC will be submitted to LPA via email by the due date.
	8 9 10 11 12 13 14	Based on the observations and interview, the backyard patio ground is uneven/unstable and may potentially be a safety risk to R1, who has a motor impairment. This poses a potential Health, Safety, or Personal Rights risk to the person in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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 Santos	TELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Jessica Cho	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2023

LIC9099 (FAS) - (06/04)

Page: 5 of 5