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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336403028
Report Date: 02/15/2023
Date Signed: 02/15/2023 10:27:31 AM

Unsubstantiated


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
02/07/2023 and conducted by Evaluator Jesse Gardner
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20230207140950
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:
02/15/2023
UNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Heather Segura, AdministratorTIME COMPLETED:
10:35 AM
ALLEGATION(S):
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Licensee not following infection control requirements
Licensee not providing resident with healthful accommodations
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jesse Gardner arrived unannounced to conduct an investigation into the allegations listed above. LPA met with Administrator Heather Segura and explained the purpose of the visit. LPA conducted a tour of the facility.

It was alleged that Staff One (S1) gave Resident One (R1) their toothbrush without washing R1's hands after assisting them utilizing the commode. It was further alleged that feces was found on R1's toilet, and blood on R1's sheets, and pillowcase.

Continued on LIC9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Jesse GardnerTELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023
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-20230207140950
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: 02/15/2023
NARRATIVE
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Through observation, LPA found that R1's room is in immaculate order. There was no infection control concern upon LPA inspection. No feces, or blood was found. Through interview with staff, Resident One (R1), and confidential witness, LPA found that there were conflicting accounts of the incident with no other witnesses present.

Thus, this allegation is UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

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

DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2