306005628-10-7-2020-22-AS-SSAS-BU85VX-20201008201817

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005628
Report Date: 10/07/2020
Date Signed: 10/07/2020 05:56:58 PM

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
08/31/2020 and conducted by Evaluator Kathrina Chin

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200831121045

FACILITY NAME:	SUNNY CARE		FACILITY NUMBER:	306005628
ADMINISTRATOR:	PAO, WESLEY		FACILITY TYPE:	740
ADDRESS:	4662 SCHOOL ST		TELEPHONE:	(657) 363-8436
CITY:	YORBA LINDA	STATE: CA	ZIP CODE:	92886
CAPACITY:	6	CENSUS: 5	DATE:	10/07/2020
		UNANNOUNCED	TIME BEGAN:	02:28 PM
MET WITH:	Wesley Pao, Administrator		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Facility staffing is not sufficient to meet resident's needs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Kathrina Chin contacted the facility via telephone for the purpose of presenting the findings of the complaint investigation due to COVID-19 and pre-cautionary measures. LPA Chin identified herself and discussed the findings with Wesley Pao, Administrator.

On September 3, 2020, LPA Chin conducted an interview of resident 1(R1) and two staff members. On September 22, 2020, LPA interviewed four residents(R2. R3, R4, R5) and the responsible party for R5. Three residents interviewed stated that there is sufficient staff to meet their needs. R4 and R5 did not respond when asked some questions. The responsible party for R5 said that she was at the facility several times a week prior to the no visitation due to COVID-19. She stated that there were two staff working in the facility every day caring for 5 to 6 residents. She stated that there were sufficient staff and R5 was receiving proper care and supervision. LPA reviewed LIC 500 Personnel Report and Staff schedule indicating weekend caregivers and relievers. (Continued LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina Chin	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2020

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-20200831121045

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: SUNNY CARE	FACILITY NUMBER: 306005628
	VISIT DATE: 10/07/2020

NARRATIVE

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The Department has investigated the complaint alleging that the facility staffing is not sufficient to meet resident's needs. Based on the information gathered during the investigation and review of all documents obtained, the allegation is deemed unsubstantiated. 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 teleconference was conducted with Wesley Pao, Administrator and LPA Chin discussed and read this report. A copy of this report will be provided via email including appeal rights. Wesley Pao agreed to confirm the receipt of the document, review the report and return a signed copy.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina Chin	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2020

LIC9099 (FAS) - (06/04)

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