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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336403028
Report Date: 10/10/2022
Date Signed: 10/10/2022 12:17:24 PM

Unfounded


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
09/27/2022 and conducted by Evaluator Jesse Gardner
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20220927104542
FACILITY NAME:SUNRISE AT CANYON CRESTFACILITY NUMBER:
336403028
ADMINISTRATOR:SEGURA, HEATHERFACILITY TYPE:
740
ADDRESS:5265 CHAPALA DRTELEPHONE:
(951) 686-6075
CITY:RIVERSIDESTATE: CAZIP CODE:
92507
CAPACITY:88CENSUS: 66DATE:
10/10/2022
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Eden Rivera, Business Office CoordinatorTIME COMPLETED:
12:25 PM
ALLEGATION(S):
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Facility administering medication without prescription
INVESTIGATION FINDINGS:
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13
Licensing Program Analyst (LPA) Jesse Gardner arrived unannounced to the facility to deliver findings to an investigation into the above allegation. LPA arrived and met with Business Office Coordinator Eden Rivera and advised the purpose of the visit, and toured the facility.

Regarding the allegation, "Facility administering medication without prescription", LPA conducted interviews with staff, and reviewed, and took copies of pertinent documents. The investigation revealed that the facility, in fact, had a prescription for the THC/CBD oil, and were administering to Resident One (R1) as ordered by the physician.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Jesse GardnerTELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2022
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-20220927104542
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: SUNRISE AT CANYON CREST
FACILITY NUMBER: 336403028
VISIT DATE: 10/10/2022
NARRATIVE
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As such, the allegation was found to be UNFOUNDED. LPA determined that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted and a copy of this report was discussed with and provided to Executive Director Heather Segura along with a copy of the LIC811.
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Jesse GardnerTELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2