336403516-6-25-2021-18-AS-JESL-C4PQMA-20210707121714

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336403516
Report Date: 06/25/2021
Date Signed: 06/25/2021 01:48:49 PM

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
10/01/2020 and conducted by Evaluator Crystal Colvin

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20201001164407

FACILITY NAME:	SUN CITY GARDENS		FACILITY NUMBER:	336403516
ADMINISTRATOR:	TED HOLT		FACILITY TYPE:	740
ADDRESS:	28500 BRADLEY ROAD		TELEPHONE:	(951) 679-2391
CITY:	SUN CITY	STATE: CA	ZIP CODE:	92586
CAPACITY:	74	CENSUS: 36	DATE:	06/25/2021
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Bituin Garcia - Assisted Living Director		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Resident sustained multiple skin tears while in care

Staff did not ensure that resident was adequately fed

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Crystal Colvin made an unannounced visit to the facility for the purpose of delivering findings for the complaint investigation with the above allegation(s). LPA Colvin spoke with Assisted Living Director Bituin Garcia, as there is no current Administrator for the facility, and reviewed the following findings:

Regarding the allegation "Resident sustained multiple skin tears while in care" - Through interviews and review of documents, LPA Colvin was able to confirm that the resident (R1) was not a resident in the licensed facility, but rather lived in the Independent Living Apartments that are not covered by the licensed through Community Care Licensing (CCL). This Department does not have jurisdiction over this area and as a result the allegation was deemed as UNFOUNDED. This agency has investigated the complaint alleging Resident sustained multiple skin tears while in care. We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal Colvin	TELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:	DATE: 06/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2021

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-20201001164407

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: 06/25/2021

NARRATIVE

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Regarding the allegation "Staff did not ensure that resident was adequately fed" - Through interviews and review of documents, LPA Colvin was able to confirm that the resident (R1) was not a resident in the licensed facility, but rather lived in the Independent Living Apartments that are not covered by the licensed through Community Care Licensing (CCL). This Department does not have jurisdiction over this area and as a result the allegation was deemed as UNFOUNDED. This agency has investigated the complaint alleging Staff did not ensure that resident was adequately fed. We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.

An exit interview was conducted with Assisted Living Director Bituin Garcia and a copy of this report was provided.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal Colvin	TELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:	DATE: 06/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2021

LIC9099 (FAS) - (06/04)

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