306005423-3-14-2023-22-AS-SSAS-CQ52RF-20230320173729

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005423
Report Date: 03/14/2023
Date Signed: 03/14/2023 12:35:41 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
11/10/2020 and conducted by Evaluator Patricia Velazquez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20201110145649

FACILITY NAME:	SUNRISE ASSISTED LIVING AT TUSTIN		FACILITY NUMBER:	306005423
ADMINISTRATOR:	TYLER HAWK		FACILITY TYPE:	740
ADDRESS:	12291 S NEWPORT AVE		TELEPHONE:	(714) 544-5959
CITY:	SANTA ANA	STATE: CA	ZIP CODE:	92705
CAPACITY:	70	CENSUS: 46	DATE:	03/14/2023
		UNANNOUNCED	TIME BEGAN:	09:16 AM
MET WITH:	Bryan Reamer - Yu - Executive Director		TIME COMPLETED:	12:55 PM

ALLEGATION(S):

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Staff falsified documents
Staff touched resident inappropriately
Staff transferred resident roughly resulting in bruises
Staff is rough with residents in care
Staff speaks inappropriately to residents in care

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.

On today's visit LPA Velazquez conducted interviews with residents and staff. LPA Velazquez also requested copies of facility and resident records. During the course of the investigation the following was revealed: LPA Michelle Reed conducted the initial complaint visit on November 18, 2020 and obtained copies of pertinent records. LPA Velazquez conducted interviews with residents, the reporting party, and staff. Eleven of eleven individuals interviewed provided conflicting statements and could not corroborate any of the above allegations. Six of six individuals interviewed felt they were well-cared for here at the facility. The records reviewed included pertinent documents from Staff (S) #1's file, Resident (R) #1, R2, R3, and R4's files. The resident records reviewed included New Resident Admission Sheet, Preplacement Appraisal Information, Resident Appraisal, Physician's Reports, Behavior Tracking Log, and other Resident Assessments. Three of the four individuals listed as part of the allegations no longer live here as they have either moved out or passed away.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (713) 334-2062
LICENSING EVALUATOR NAME: Patricia Velazquez	TELEPHONE: (949) 236-0556
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023

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-20201110145649

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: SUNRISE ASSISTED LIVING AT TUSTIN	FACILITY NUMBER: 306005423
	VISIT DATE: 03/14/2023

NARRATIVE

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Based on the observations made by LPAs Michelle Reed and 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: Staff falsified documents, Staff touched resident inappropriately, Staff transferred resident roughly resulting in bruises, Staff is rough with residents in care, and Staff speaks inappropriately to residents in care are all deemed UNSUBSTANTIATED.

An exit interview was conducted with Executive Director Bryan Reamer - Yu and a copy of this report along with the LIC 811s were provided at the time of this visit. Due to technical difficulties, LPA Patricia Velazquez was not able to print the report nor the LIC 811s. LPA Velazquez will email these documents to Executive Director Bryan - Reamer - Yu later today.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (713) 334-2062
LICENSING EVALUATOR NAME: Patricia Velazquez	TELEPHONE: (949) 236-0556
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023

LIC9099 (FAS) - (06/04)

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