336403516-9-16-2023-18-AS-KCLS-CVUPXN-20230920114233

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336403516
Report Date: 09/16/2023
Date Signed: 09/16/2023 12:27:28 PM

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
01/04/2021 and conducted by Evaluator Bernadette Allen

COMPLAINT CONTROL NUMBER: 18-AS-20210104172533

FACILITY NAME:	SUN CITY GARDENS		FACILITY NUMBER:	336403516
ADMINISTRATOR:	ANGELA SCOTT-KAPILOFF		FACILITY TYPE:	740
ADDRESS:	28500 BRADLEY ROAD		TELEPHONE:	(951) 679-2391
CITY:	SUN CITY	STATE: CA	ZIP CODE:	92586
CAPACITY:	0	CENSUS: 0	DATE:	09/16/2023
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Esmeralda Cervantes -Marketing Assistant		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Staff did not provide adequate supervision.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bernadette Allen an conducted an unannounced visit to initiate and deliver findings for the mentioned allegations. LPA Allen met with Esmeralda Cervantes Marketing Assistant who was informed of the purpose of the visit.

LPA Allen conducted interviews with facility staff, residents, and outside parties. The interview conducted with Resident 1(R1) stated that there was a neighbor that had a habit of coming into their room uninvited. R1 did not know the name of the individual but confirmed that Resident 2 (R2) lived in the same building. R1 was asked about adequate supervision and R1 stated that there was enough staff R2 would just come in their room randomly and would leave when asked. R1 stated that R2 never did anything to harm them but kept entering their room without permission. R1 stated they started locking the door after a few unwanted visits. R1 stated that R2 had a friend that lived right above theirs and R2 seemed to be confused about which room was which. R1 stated facility staff was informed of the problem which was eventually resolved.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Bernadette Allen	TELEPHONE: (951) 897-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2023

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-20210104172533

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: SUN CITY GARDENS	FACILITY NUMBER: 336403516
	VISIT DATE: 09/16/2023

NARRATIVE

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Based on interviews conducted with staff, residents, and outside parties the above finding is Unsubstantiated. A finding of unsubstantiated means although the allegations 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 and a copy of this report and appeal rights were provided to Esmeralda Cervantes.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Bernadette Allen	TELEPHONE: (951) 897-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2023

LIC9099 (FAS) - (06/04)

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