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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881358
Report Date: 05/01/2024
Date Signed: 05/01/2024 10:26:11 AM

Unfounded


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
04/23/2024 and conducted by Evaluator Sara Martinez
COMPLAINT CONTROL NUMBER: 18-AS-20240423144356
FACILITY NAME:SUN CITY GARDENSFACILITY NUMBER:
331881358
ADMINISTRATOR:DIANE DOMINGOFACILITY TYPE:
740
ADDRESS:28500 BRADLEY ROADTELEPHONE:
(951) 679-2391
CITY:SUN CITYSTATE: CAZIP CODE:
92586
CAPACITY:74CENSUS: 66DATE:
05/01/2024
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Executive Director Diane DomingoTIME COMPLETED:
10:35 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not ensure resident's room was free of rodents
Staff are not providing a healthful environment for resident
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Sara Martinez made an unannounced visit to initiate the investigation regarding the allegation(s) listed above. LPA was granted entry and met with Executive Director Diane Domingo and explained the purpose of the visit.

LPA conducted a tour of the interior/exterior areas of the facility, conducted interviews, and requested copies of pertinent documentation. Interview with Executive Director Domingo revealed Resident One (R1) lives in the independent living units at the facility. Record review of the facility's assisted living and memory care resident roster confirmed R1 lives in the facility's independent living units which is not licensed by the Department and Community Care Licensing (CCL) does not have jurisdiction over the independent living units of the facility. Therefore the allegation(s) listed above has been deemed UNFOUNDED at this time. A finding that the complaint is unfounded means the allegation is false, could not have happened, and/or is without a reasonable basis. Cross reports will be made to notify the appropriate parties of the concerns reported. A exit interview was conducted and a copy of this report along with LIC811 - confidential names list was provided to Domingo.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Tricia DanielsonTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Sara MartinezTELEPHONE: (951) 605-0913
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2024
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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