306005628-4-19-2021-22-AS-SSAS-C3BQ63-20210524115250

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005628
Report Date: 04/19/2021
Date Signed: 04/19/2021 05:57:04 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
01/15/2021 and conducted by Evaluator Kathrina Chin

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20210115152549

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: 6	DATE:	04/19/2021
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Wesley Pao, Administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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1) Resident is being financially abused while in care.

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 January 20, 2021, LPA Chin conducted an interview of Wesley Pao, AD who denied every taking any money from R1. LPA interviewed two staff members, S1 and S2 and both staff members denied financially abusing R1. Both denied ever taking money from R1. On January 25, 2020, LPA interviewed resident 1 (R1) who reported that one female staff financially abused him at last skilled nursing facility he stayed at. R1 further indicated that the female was a social worker and the female's name began with the letter "C." R1 reported that none of the staff at this facility ever financially abused him or took money from him. He said, "Nobody is trying to steal money from me here. That has never happened." He said that he is treated well by staff at Sunny Care. R1 also said that this staff or social worker from the skilled nursing facility forced him to sign papers but he does not know what he signed. (Continued on LIC 9099C).

Unfounded

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: 04/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2021

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 4

Control Number 22-AS-20210115152549

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: 04/19/2021

NARRATIVE

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LPA spoke to an Ombudsman representative who also confirmed that the R1 indicated that it was a staff at his previous skilled nursing he stayed at who allegedly abused him. The information has been cross reported to another State agency for follow up.

LPA Chin reviewed R1's physician's report. Resident appears to alert and able to communicate his needs. Resident is in charge of his health and financial affairs. Resident is on hospice care beginning January 6, 2021.

This agency has investigated the complaint and is determined to be 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 teleconference was conducted with Wesley Pao and LPA Chin discussed and read this report. A copy of this report will be provided via email. Wesley Pao agreed to 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: 04/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 4

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
01/15/2021 and conducted by Evaluator Kathrina Chin

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20210115152549

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: 4	DATE:	04/19/2021
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Wesley Pao, Administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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2) Facility is not following resident's care plan.

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 January 20, 2021, LPA Chin conducted an interview of Wesley Pao, AD that his staff cut resident 1's(R1) fingernails. Also, on January 19, 2021, a podiatrist came to the facility and cut R1's toenails. LPA reviewed the report from the podiatrist which confirmed that R1 toenails were cut and was seen. He said that he has no issues or problems with the care from the staff at this facility. LPA interviewed R1 on January 20 and he said that his toenails were cut by the podiatrist that came recently. Resident 1( R1) is on hospice care from Green Meadows Hospice starting on January 6, 2021. Wesley Pao, AD reported that R1 is being seen by hospice staff twice a week. Prior to hospice, Wesley reported that R1 was under the care of a home health nurse. (Continued on LIC 9099C).

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: 04/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2021

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 4

Control Number 22-AS-20210115152549

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: 04/19/2021

NARRATIVE

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LPA, Kathrina Chin reviewed the Needs and Services plan. No concerns noted. Wesley Pao AD indicated that the choledrain was taken out the hospital when the hospice agency sent the resident out to the hospital in February 2021. Mr. Pao indicated that he is providing the best care possible to R1.

The Department has investigated the complaint alleging that the facility is not following resident's care plan. 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 and appeal rights explained and a copy of appeal rights provided via email. 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: 04/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2021

LIC9099 (FAS) - (06/04)

Page: 4 of 4