331881358-5-17-2025-18-AS-APAO-DHKMNM-20250612094542

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881358
Report Date: 05/17/2025
Date Signed: 05/17/2025 01:54:01 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 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
08/14/2023 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 18-AS-20230814190432

FACILITY NAME:	SUN CITY GARDENS		FACILITY NUMBER:	331881358
ADMINISTRATOR:	ROBYN REBOLLAR		FACILITY TYPE:	740
ADDRESS:	28500 BRADLEY ROAD		TELEPHONE:	(951) 679-2391
CITY:	SUN CITY	STATE: CA	ZIP CODE:	92586
CAPACITY:	74	CENSUS: 58	DATE:	05/17/2025
		UNANNOUNCED	TIME BEGAN:	08:10 AM
MET WITH:	Brenda Sanchez - Resident Service Director		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Facility is retaining a resident that requires a higher level of care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose Tan conducted an unannounced subsequent visit at this facility to further investigate the above allegation. LPA met with Brenda Sanchez and explained the reason for the visit.

LPA conducted physical plant tour at 8:38 AM, requested copies of facility documents relevant to the investigation at 9:05 AM, reviewed records between 9:15 AM to 10:00 AM and interviewed staff and resident between 10:00 AM to 10:35 AM. Regarding the allegation that Resident #1 (R1) was not capable of making medical and financial decisions independently and R1's memory is declining rapidly. LPA's record review revealed that R1 was admitted at the facility on 11/15/22, declared self-responsible and did not list any family member on record. Further review also revealed that upon admission, R1 had the capacity for self-care and able to do own Activity of Daily Living (ADL)'s aside from minimal assistance on bathing. On 08/04/23, R1 had medication payment issues that the Adult Protective Services (APS) were called to get involved to settle the payment and that R1 needed to have a social worker and Power of Attorney (POA) to handle R1's financial and medical affairs.
(continued on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2025

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 18-AS-20230814190432

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: SUN CITY GARDENS	FACILITY NUMBER: 331881358
	VISIT DATE: 05/17/2025

NARRATIVE

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(continued from LIC 9099)

LPA Goodrich's interview with former Resident Care Director (RSD) on 08/22/23 and Executive Director on 09/11/23 revealed that they have contacted and worked with APS and other agency to have R1 appointed a Public Guardian but nothing happened. The facility contacted and located R1's family member and eventually had a family member as a responsible party for medical and financial matters for R1 on 01/18/2024. During this visit, LPA observed that R1 now resides at the facility's memory care unit and observed to be neat, clean and stated that staff are taking good care of R1.

Further review also revealed that on 05/21/24, R1 was appointed a temporary public guardian from Riverside County Public Guardian office by the Superior Court of California, County of Riverside

Based on the information gathered during this and prior visit, there is insufficient evidence to prove the allegation and therefore deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2025

LIC9099 (FAS) - (06/04)

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