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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336403516
Report Date: 08/02/2022
Date Signed: 08/02/2022 11:32:57 AM


Document Has Been Signed on 08/02/2022 11:32 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 GARDENSFACILITY NUMBER:
336403516
ADMINISTRATOR:BITUIN D GARCIAFACILITY TYPE:
740
ADDRESS:28500 BRADLEY ROADTELEPHONE:
(951) 679-2391
CITY:SUN CITYSTATE: CAZIP CODE:
92586
CAPACITY:74CENSUS: 44DATE:
08/02/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:34 AM
MET WITH:Bituin Dizon-Garcia, AdministratorTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA), Stephanie Torres, made an unannounced visit to the facility to conduct a case management visit regarding a report of staff abuse. The LPA met with Bituin Dizon-Garcia, Administrator, and informed her of the purpose of the visit.

On July 27, 2022 the Department received a Report of Suspected Dependent Adult/Elder Abuse (SOC 341). The report states, "On Monday, July 25th on the PM Shift...[there was] a situation between Staff One (S1)(Sun City Care Giver) and one of the residents in Memory Care, Resident One (R1). It was reported R1 had unplugged the DVD player and then grabbed the TV remote in the TV room. S1 was trying to take the remote out of R1's hands forcefully while yelling at R1 to let them go. R1 sat down in a chair while S1 was still trying to retrieve the remove control. R1 was getting mad and hit S1 on the arm. S1 slapped R1 back on the arm and told the resident, "Don't you hit me again, you hear me..."

In addition, the Administrator reported there was another incident involving S1 which was reported to the Department. The LPA reviewed a second SOC 341 which states, "One Monday, July 25th on the PM Shift, [a witness] walked into the TV room in Memory Care because [they] heard yelling. [The witness observed S1] being rough with [Resident Two (R2)]...while transferring [them] from the chair to the wheelchair. Not only did S1 transfer [the resident] incorrectly, but S1 was also yelling at [R2] saying, "come on..., just sit down." [R2]was yelling, "No stop, I am going to fall." And "You're hurting my arm. [R2] was in tears"

The LPA conducted staff/resident interviews, reviewed records, and took copies of pertinent documentation. R1 was interviewed though could not confirm nor deny the incident took place. R2 was also interviewed and reported they did recall the incident. R2 reported S1 was rough with them, however, the staff did not hurt them. R1 and R2 have health conditions which impact their ability to recall events/details. According to Garcia, S1 was terminated as a result of the incidents. S1 has not been interviewed at the time of this report.
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Stephanie TorresTELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:
DATE: 08/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/02/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 08/02/2022
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No health and safety concerns were observed during this investigation. If violations are observed following this date a return will be conducted to address concerns.

This report was reviewed with the Administrator and a copy was provided.
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Stephanie TorresTELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2022
LIC809 (FAS) - (06/04)
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