306005264-3-1-2023-22-AS-SSAS-CPL34K-20230303165517

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005264
Report Date: 03/01/2023
Date Signed: 03/01/2023 03:08:57 PM

Unfounded

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
02/24/2023 and conducted by Evaluator Jessica Cho

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230224101354

FACILITY NAME:	SUNNYVALE		FACILITY NUMBER:	306005264
ADMINISTRATOR:	SHINMAR, MUNDEEP CHAND		FACILITY TYPE:	740
ADDRESS:	11592 VICILIA STREET		TELEPHONE:	(714) 867-6576
CITY:	GARDEN GROVE	STATE: CA	ZIP CODE:	92841
CAPACITY:	6	CENSUS: 6	DATE:	03/01/2023
		UNANNOUNCED	TIME BEGAN:	09:26 AM
MET WITH:	Sunita Chand, Administrator & Mundeep Shinmar, Licensee/Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff did not properly maintain the home.
Staff did not provide comfortable accomodations for the resident.
Staff did not properly maintain the resident's room.
Staff did not replenish hygiene product for the facility.
Staff did not ensure the resident is being properly fed while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jessica Cho conducted an unannounced visit for the purpose to investigate into the above allegations. LPA met with Caregivers Maria and Cornel Moroaica upon entry and stated the purpose of the visit. Caregiver Maria notified Administrator (Admin) Sunita Chand by telephone, and Admin Sunita Chand and Licensee/Administrator Mundeep Shinmar arrived at the facility approximately 10:00am. During the course of the investigation, LPA conducted a tour of the physical plant, reviewed and obtained copies of records for Resident 1 (R1) and Resident 2 (R2). Interviews were conducted with R1, staff, and Administrators. The following are the findings which involved observations, record review, and interviews:

On the allegation that staff did not properly maintain the home, it was alleged that the facility was dark and the tile floors were dirty. LPA observed that the tile floors were clean and traces of food and dirt were not observed during the visit. The facility including Bedroom #3 was well lit with natural light and the lights were in operating condition.

Unfounded

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: 03/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023

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-20230224101354

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: SUNNYVALE	FACILITY NUMBER: 306005264
	VISIT DATE: 03/01/2023

NARRATIVE

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On the allegation that staff did not provide comfortable accommodations for the resident, LPA observed the window in Bedroom #3 was slightly open for ventilation. Per Google's weather report, the temperature in Garden Grove measured at 54 degrees Fahrenheit on today's date. The indoor temperature of the facility measured at 71 degrees Fahrenheit and 70.1 degrees Fahrenheit in Bedroom #3. A comfortable temperature was maintained for residents during the visit as mandated per Title 22 Regulations. Four of four individuals stated that five out of six residents use the bathroom located by the living room. The bathroom in the hallway is used by staff, visitors, and Resident 3 (R3) who is independent. On the allegation that staff did not properly maintain the resident's room, LPA observed the following in Bedroom #3: the bed rails were clean, the trash can with soiled diaper pads were not observed, walls were free of dried nasal mucus, and odor was not present during the visit. On the allegation that staff did not replenish hygiene product for the facility, LPA observed sufficient quantity of hand soaps in two out of two bathrooms. On the allegation that staff did not ensure the resident is being properly fed while in care, it was alleged that the condition of Resident 1 (R1) requires a feeding tube. LPA observed R1 not on a feeding tube and having lunch in the dining room approximately 11:30am. Per review of Vitas Hospice records, records do not indicate R1 requiring a feeding tube.

Therefore, this agency has investigated the complaint. Based on the observations made, interviews conducted, and the records reviewed, the above allegations are deemed UNFOUNDED. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.

An exit interview was conducted with Administrator Sunita Chand and Licensee/Administrator Mundeep Shinmar, and this report along with the LIC811 were provided during this visit.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Jessica Cho	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 03/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023

LIC9099 (FAS) - (06/04)

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