336403516-8-2-2022-18-AS-DMUN-CJGUL8-20220921154021

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336403516
Report Date: 08/02/2022
Date Signed: 08/02/2022 11:53:28 AM

Unfounded

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
08/01/2022 and conducted by Evaluator Stephanie Torres

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20220801085916

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: 44	DATE:	08/02/2022
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Bituin Dizon-Garcia, Administator		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff did not conduct a reappraisal on resident in care
Staff does not provide proper medication assistance to resident in care
Staff does not properly assist resident with their toileting needs
Resident's room does not have a signal system
Staff locked resident in their room

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Stephanie Torres, made an unannounced visit to the facility to initiate the investigation into the above allegations. The LPA met with Bituin Dizon-Garcia, Administrator, and informed her of the purpose of her visit.
On this visit the LPA conducted staff interviews, reviewed records and took copies of pertinent documentation. The Administrator reported Resident One (R1) does not reside in the Assisted Living or Memory Care units of the licensed facility. The Administrator reported R1 does reside in the Independent unit of Sun City Gardens, which is owned by the same corporation, though is not licensed by the Department. The LPA reviewed the resident roster and did not observe R1's name listed on the report. The LPA also spoke with staff of the Independent unit, who reported R1 is a resident of their building. Additional investigation could not be conducted, due to the Department having no jurisdiction of the Independent unit of Sun City Gardens. Therefore, due to R1 not residing in the licensed facility these allegations are deemed UNFOUNDED. Cross reports will be made to notify the appropriate parties of the concerns reported. This report was reviewed with the Administrator and a copy was provided

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Stephanie Torres	TELEPHONE: (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.

LIC9099 (FAS) - (06/04)

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