<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 315001863
Report Date: 06/15/2023
Date Signed: 06/15/2023 10:31:58 AM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/31/2023 and conducted by Evaluator Melissa Parks
PUBLIC
COMPLAINT CONTROL NUMBER: 59-AS-20230531160438
FACILITY NAME:ANGELS SUNRISE VILLAFACILITY NUMBER:
315001863
ADMINISTRATOR:KUMAR, ALPESHFACILITY TYPE:
740
ADDRESS:2135 LARKFLOWER WAYTELEPHONE:
(916) 409-0600
CITY:LINCOLNSTATE: CAZIP CODE:
95648
CAPACITY:6CENSUS: 6DATE:
06/15/2023
UNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Alpesh KumarTIME COMPLETED:
10:45 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff abusing residents
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Melissa Parks arrived unannounced on Thursday June 15, 2023, to complete and deliver findings to a complaint received on 5/31/2023. LPA met with Administrator Alpesh and explained purpose of visit.

Throughout the course of the investigation, LPA interviewed staff including the Administrator and staff S1 – S6. LPA reviewed R1 – R6 facility files. All residents have a Dementia diagnosis. R1 – R6 LIC602’s has listed confused/disoriented, aggressive, or sundowning behavior. LPA contacted POA for R1, R4, R5, and R6. All POAs contacted stated that there were no concerns regarding staff being agressive or abusing residents. LPA observed all six residents. No redness or bruising was observed. Additionally, LPA observed staff interacting with residents. No residents appeared to be afraid or intimidated by staff. Furthermore, R2 and R3 consistently communicated with staff and asked staff to sit/be near them. While conducting a facility visit on 6/1/2023, LPA observed R1, R3, and R6 to have visitors. Visitors stated that they believed their loved ones were well taken care of. All stated that they believed the residents were treated with dignity and respect.
Unfounded
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa ParksTELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2023
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 2
Control Number 59-AS-20230531160438
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: ANGELS SUNRISE VILLA
FACILITY NUMBER: 315001863
VISIT DATE: 06/15/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Based on the evidence provided, the preponderance of evidence standards was not met, therefore, the above allegation is found to be UNFOUNDED. An unfounded allegation means that the allegation was false, could not have happened and/or is without a reasonable basis.

Exit interview conducted. A copy of this report was emailed to the Administrator.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa ParksTELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2