331881358-7-17-2024-18-AS-TDAN-D7MUCH-20240729152758

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881358
Report Date: 07/17/2024
Date Signed: 07/17/2024 04:11:47 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
07/11/2024 and conducted by Evaluator Javina George

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20240711084938

FACILITY NAME:	SUN CITY GARDENS		FACILITY NUMBER:	331881358
ADMINISTRATOR:	DIANE DOMINGO		FACILITY TYPE:	740
ADDRESS:	28500 BRADLEY ROAD		TELEPHONE:	(951) 679-2391
CITY:	SUN CITY	STATE: CA	ZIP CODE:	92586
CAPACITY:	74	CENSUS: 60	DATE:	07/17/2024
		UNANNOUNCED	TIME BEGAN:	02:38 PM
MET WITH:	Elizabeth "Diane" Domingo,		TIME COMPLETED:	04:20 PM

ALLEGATION(S):

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Due to neglect, resident sustained pressure injuries/bruises

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 Executive Director Elizabeth "Diane" Domingo and explained the purpose of the visit and the elements of the allegation.

On 7/11/24 Community Care Licensing received a complaint alleging due to neglect, resident sustained pressure injuries/bruises. Resident #1 (R1) was admitted to the facility on 7/7/24, upon admission the Resident Services Director Bituin Garcia was conducting a physical assessment and observed R1 to have "weeping" (fluid leaking from their legs) and multiple wounds. R1 was observed to have wounds on both their upper and lower extremities, as well as bruising to upper and lower extremities, and their head drooping to the left side. At approximately 3:31pm emergency medical services was contacted and transported R1 to the hospital due to the condition upon admission. Per an interview with Resident Services Director there was a preadmission interview that was conducted via Facetime on 7/2/24 due to the distance of R1's previous residence and the facility. However no wounds were observed. R1 returned to facility on 7/15/24 and is

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Tricia Danielson	TELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (951) 217-3970
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2024

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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Control Number 18-AS-20240711084938

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: 07/17/2024

NARRATIVE

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receiving additional services from a third party agency.

Per the narrative charting dated 7/7/24 reviewed revealed that R1 was admitted to the facility with the wounds, therefore the allegation of due to neglect, resident sustained pressure injuries/bruises is unfounded. A finding that the complaint is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

An exit interview was conducted and a copy of this report was provided to Executive Director Elizabeth "Diane" Domingo.

SUPERVISOR'S NAME: Tricia Danielson	TELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (951) 217-3970
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2024

LIC9099 (FAS) - (06/04)

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