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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881358
Report Date: 05/04/2023
Date Signed: 05/04/2023 03:52:00 PM

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
04/28/2023 and conducted by Evaluator Jesse Gardner
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20230428100816
FACILITY NAME:SUN CITY GARDENSFACILITY NUMBER:
331881358
ADMINISTRATOR:ROBYN REBOLLARFACILITY TYPE:
740
ADDRESS:28500 BRADLEY ROADTELEPHONE:
(951) 679-2391
CITY:SUN CITYSTATE: CAZIP CODE:
92586
CAPACITY:74CENSUS: 66DATE:
05/04/2023
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Robyn Rebollar, AdministratorTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff do not respond to resident call buttons
Staff do not safeguard resident's personal property
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jesse Gardner arrived unannounced to the facility to conduct a complaint investigation into the allegations listed above. LPA met with Administrator Robyn Rebollar and informed her of the purpose of the visit.

It was alleged that for the past 4 months the staff have not responded to the resident's pagers (call buttons) because the pagers do not work. For 24 hours, 3 shifts, there are a total of 17 staff that work the 24 hours. Of the 17 staff, LPA found 4 pagers. 3 of which were broken, leaving 1 pager working to respond for resident pushes. Staff interivew indicated that due to the broken pagers, response times for button pushes would diminish for residents in care.

Continued on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Jesse GardnerTELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
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 5
Control Number 18-AS-20230428100816
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: SUN CITY GARDENS
FACILITY NUMBER: 331881358
VISIT DATE: 05/04/2023
NARRATIVE
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Through interviews conducted with residents, LPA found that their pendant's are in working order. Based on interviews conducted, the preponderance of evidence standard has been met, therefore the allegation was found to be SUBSTANTIATED.

It was then alleged that Resident 1 (R1) does not receive their packages. Interview with R1 revealed that R1 has their mail, it just is not delivered consistently. Interviews with staff and residents revealed that mail is delivered by the Post Office to the front desk to be sorted for Assisted Living Delivery. From there, staff separate the mail, and deliver to the residents. On the day of the visit, LPA observed loose mail left on a table in the Activities Room with no supervision. Additionally, interviews with residents concluded that there is a problem receiving their mail on a regular basis. Therefore, the preponderance of evidence standard has been met, thus the allegation was found to be SUBSTANTIATED.

A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met.

The facility was cited under California Code of Regulations (Title 22, Division 6, Chapter 8),on the attached LIC9099-D.

SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Jesse GardnerTELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 18-AS-20230428100816
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: SUN CITY GARDENS
FACILITY NUMBER: 331881358
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/04/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/05/2023
Section Cited
CCR
87468.2(a)(8)
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Additional Personal Rights of Residents in Privately Operated Facilities: (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights:(8) To be free from neglect, financial exploitation, involuntary seclusion...This requirement was not being met as evidenced by:
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On the day of visit, Licensee has provided 5 new working pagers to cut response times, and provide care for residents. Additionally, Licensee agrees to conduct in-service training on the cited regulation, and submit proof of training to LPA by POC date.
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Based on interviews conducted with staff and residents, LPA discovered that there were not enough working pagers to adequately respond to residents requests in a timely manner. This poses a immediate personal rights risk to residents in care.
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Type B
05/11/2023
Section Cited
CCR
87468.1(a)(15)
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Personal Rights of Residents in All Facilities-
(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(15) To send and receive unopened correspondence in a prompt manner.
This requirement was not met as evidenced by:
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Licensee to develop a plan to distribute mail to the residents that does not infringe their personal rights. Additionally, Licensee to conduct in-service training on the cited regulation, and provide proof of both to LPA by POC date.
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Based on interview, LPA found that R1 had received their mail; however, along with other residents, not in a timely fashion. This poses a potential personal rights violation to residents in care.
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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.
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Jesse GardnerTELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
04/28/2023 and conducted by Evaluator Jesse Gardner
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20230428100816

FACILITY NAME:SUN CITY GARDENSFACILITY NUMBER:
331881358
ADMINISTRATOR:ROBYN REBOLLARFACILITY TYPE:
740
ADDRESS:28500 BRADLEY ROADTELEPHONE:
(951) 679-2391
CITY:SUN CITYSTATE: CAZIP CODE:
92586
CAPACITY:74CENSUS: 66DATE:
05/04/2023
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Robyn Rebollar, AdministratorTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff do not accord safe, healthful and comfortable equipment for resident’s toileting use
Staff do not accord safe, healthful and comfortable accommodations for resident to enter bathroom
Staff do not answer the facility phone
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jesse Gardner arrived unannounced to the facility to conduct a complaint investigation into the allegations listed above. LPA met with Administrator Robyn Rebollar and informed her of the purpose of the visit. LPA then toured the facility.

It was alleged that Resident 1's (R1) toilet support is not secure. Through interview with R1, R1 stated that the toilet support is useful; however, the issue was that it was not the original support that they had before moving from the second floor to the first floor. The support that R1 originally had did not fit R1's toilet on the first floor after the move and caused the toilet to leak.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Jesse GardnerTELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 18-AS-20230428100816
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: SUN CITY GARDENS
FACILITY NUMBER: 331881358
VISIT DATE: 05/04/2023
NARRATIVE
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The facility provided an additional support that fit the toilet. R1 does not like the support; however, the support was new provided by the facility when the facility learned that the support that was being used was not the right one for the toilet. Due to the facility providing a new support to fit the toilet that R1 has, and also the fact that R1 is able to utilize the toilet, and does so with the support, LPA was not able to dismiss the allegation; thus found the allegation was found to be UNSUBSTANTIATED.

It was then alleged that the entry-way in R1's bathroom is too narrow for R1 to ambulate their walker through, and around while using the toilet. LPA found that through interview with residents and observation, R1's walker is able to fit through the doorway and allow R1 access to the toilet; thus the allegation was UNSUBSTANTIATED and not able to be dismissed.

It was then alleged that staff due not answer the facility telephone during the day or during the night. The noted incident was involving R1 on January 23, 2023 where facility staff was alleged to not answer the phone at approximately 3:30am, when R1 had went to the hospital. LPA found that R1 had fallen at 5:00am and LPA was not able to conclude that the phone was answered or not via interview with staff and residents; however, LPA did call the facility and was met with a receptionist on the day of visit. Thus the allegation was not able to be dismissed, and therefore UNSUBSTANTIATED.

A finding of UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Jesse GardnerTELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5