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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881358
Report Date: 10/21/2024
Date Signed: 10/21/2024 01:20:45 PM

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
10/14/2024 and conducted by Evaluator Javina George
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20241014123647
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: 61DATE:
10/21/2024
UNANNOUNCEDTIME BEGAN:
12:14 PM
MET WITH:Diane Domingo, Administrator TIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Facility staff did not provide adequate supervision to resident in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to commence a complaint investigation in regards to the allegation noted above. LPA met with Administrator Diane Domingo where LPA explained the purpose of the visit and the elements of the complaint allegation. The allegation was investigated, the investigation consisted of observations, interviews and records review.

On 10/14/24 Community Care Licensing received a complaint alleging facility staff did not provide adequate supervision to resident in care. It was alleged that Resident #1 (R1) had eloped multiple times inside the facility and into another building, and had eloped from the facility and was found on the freeway. Additionally, it was alleged that R1 was able to elope due to there not being a security guard on the premises during the night time/NOC hours (10pm-7am). Per an interview with Administrator Diane the incident did in fact occur with R1 eloping and being found on the freeway and being brought back by law enforcement on 10/3/24. Diane also stated that the facility did not have a security guard but did have a night time Concierge and that as of 10/01/24, the hours were decreased for the position, resulting in there no longer being
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2024
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 18-AS-20241014123647
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: 10/21/2024
NARRATIVE
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someone up front but if assistance was needed a call would need to be made and the 24/7 staff inside the back building would assist.

LPA conducted a records review of the rent roll and facility census, that revealed R1 resides in the independent building. The department does not have jurisdiction over the independent living units of the facility. Therefore the allegation of facility staff did not provide adequate supervision to resident in care is 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.

A exit interview was conducted and a copy of this report along with LIC811 - confidential names list was provided to Diane Domingo, Administrator.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2024
LIC9099 (FAS) - (06/04)
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