336403516-3-24-2022-18-AS-JESL-CFWS4T-20220701133316

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336403516
Report Date: 03/24/2022
Date Signed: 03/24/2022 04:17:55 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
02/18/2022 and conducted by Evaluator Javina George

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20220218123609

FACILITY NAME:	SUN CITY GARDENS		FACILITY NUMBER:	336403516
ADMINISTRATOR:	BITUIN D GARCIA		FACILITY TYPE:	740
ADDRESS:	28500 BRADLEY ROAD		TELEPHONE:	(951) 679-2391
CITY:	SUN CITY	STATE: CA	ZIP CODE:	92586
CAPACITY:	74	CENSUS: 41	DATE:	03/24/2022
		UNANNOUNCED	TIME BEGAN:	04:00 PM
MET WITH:	Bituin Garcia, Administrator		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Resident suffered multiple falls resulting in injuries.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Javina George arrived unannounced at the facility to deliver findings for the allegation(s) listed above. LPA met with Bituin Garcia, Administrator and explained the purpose of the visit as well as the elements of the allegation. The allegation of Resident suffered multiple falls resulting in injuries was investigated by the department. The investigation consisted of observation, interviews and record review.

Based on information provided from interviews, Resident #1 (R1) has had a change in their condition which involves a decrease in their mobility. R1 admitted that they have fallen because of the socks that they were wearing, and the fact that they limited mobility. R1 reported not having full use of their left hand, as they are unable to move their index, middle and thumb fingers. R1 states that they use a walker to move around and has also been provided a wheelchair. R1 states that staff are very responsive as they are checking in with resident and when they use their pendant. LPA was able to corroborate R1s statement as evidenced by R1 pressing their pendant and staff responding within 2-4 minutes throughout LPAs visit.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022

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-20220218123609

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: 03/24/2022

NARRATIVE

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Per Staff # 1, R1 is receiving undocumented hourly check ins. R1s responsible party states that there are no any concerns with R1s care and note that there has been a change in resident’s physical mobility, as it is coming with their age.

Per Administrator Bituin Garcia the facility’s fall procedure if the resident is on hospice, hospice is notified immediately, a test and visual check for injuries is performed, based on the assessment hospice may come out or make a recommendation to have the resident sent out the resident is placed on alert charting for 72 hours, and the responsible party and licensing agencies are notified. Not every fall is recorded on an SIR, however if there are injuries (skin tear, fracture, and unable to move a limb) than an SIR would be warranted.

R1 has been receiving hospice services since 05/23/20, R1s responsible party is working to find another placement (a smaller setting) for R1, however due to current financial limitations R1 will remain at the facility until alternative placement becomes option.

Due to there not being enough evidence to support the allegation of Resident suffered multiple falls resulting in injuries is UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means 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, therefore the allegation is unsubstantiated at this time.

An exit interview was conducted and a copy of this report was provided to Administrator Bituin Garcia.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022

LIC9099 (FAS) - (06/04)

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