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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880689
Report Date: 11/02/2021
Date Signed: 11/02/2021 10:08:52 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/03/2021 and conducted by Evaluator Amy Goldenberg
COMPLAINT CONTROL NUMBER: 18-AS-20210903124442
FACILITY NAME:SUNRISE AT EASTVALEFACILITY NUMBER:
331880689
ADMINISTRATOR:MANIQUIS, ROXANNEFACILITY TYPE:
735
ADDRESS:7323 PRAIRIE ISLAND CIRTELEPHONE:
(909) 730-1781
CITY:EASTVALESTATE: CAZIP CODE:
92880
CAPACITY:4CENSUS: 3DATE:
11/02/2021
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Rosario Maniquis, Licensee/Administrator TIME COMPLETED:
10:40 AM
ALLEGATION(S):
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Unlawful eviction
INVESTIGATION FINDINGS:
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This unannounced visit conducted by Amy Goldenberg, Licensing Program Analyst (LPA), is to conclude this agency’s investigation into the complaint allegation mentioned above.

During the course of the investigation, interviews were conducted with staff, a review of resident (R1) records was completed, and copy of pertinent documents were obtained. In regard to the alleged violation of unlawful eviction, LPA reviewed Title 22 of The California Code of Regulations section pertaining to eviction procedures and also reviewed the 30 day eviction notice issued by Rosario Manaquis, Licensee/Administrator. Review of Title 22, Division 6, Section 85068.5 indicates that the licensee shall be permitted to evict a client by serving the client with a 30-day written notice to quit for nonpayment of the rate for basic services within ten days of the due date, failure of the client to comply with state or local law after receiving written notice of the alleged violation, failure of the client to comply with the general facility policies as
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amy Goldenberg
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2021
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 3
Control Number 18-AS-20210903124442
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: SUNRISE AT EASTVALE
FACILITY NUMBER: 331880689
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/02/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/01/2021
Section Cited
CCR
85068.5
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Eviction Procedures:The licensee shall be permitted to evict a client by serving the client with a 30-day written notice to quit for any of the following reasons...The facility
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Licensee to review section cited and submit statement of understanding by POC due date.
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has failed to meet this requirement as evidenced by failure to meet the requirement of 30 day notification and permitted reason for eviction in the notice delivered to R1 and their legal conservator.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amy Goldenberg
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20210903124442
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: SUNRISE AT EASTVALE
FACILITY NUMBER: 331880689
VISIT DATE: 11/02/2021
NARRATIVE
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specified in the admission agreement, a needs and services plan modification has been performed which determined that the client's needs cannot be met by the facility and the client has been given an opportunity to relocate, or change of use of the facility. Review of the notice of eviction letter issued to R1 revealed an issue date of 08/30/2021 and proposed move out date of 09/28/2021. This letter did not provide for a full 30 day notice to R1 or their legal conservator. Likewise, the eviction notification failed to provide information relevant to the allowable reasons for a 30 day eviction per regulation.

Based on the aforementioned, we have substantiated the complaint allegation as valid and have determined that a violation has occurred based on the preponderance of available evidence.

A copy of this report along with appeal rights are being reviewed with, and furnished to the facility representative. Please see LIC 9099D.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amy Goldenberg
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3