336403516-3-16-2023-18-AS-JESL-CQD6YK-20230328211341

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336403516
Report Date: 03/16/2023
Date Signed: 03/16/2023 03:56:10 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
07/19/2021 and conducted by Evaluator Jesse Gardner

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210719092515

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:	03/16/2023
		UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Robin Rebollar, Executive Director		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff failed to provide adequate food service for residents
Staff failed to follow resident's diet plan

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jesse Gardner conducted an unannounced visit to deliver findings of the above allegations. LPA toured the facility, and met with Robin Rebollar, Executive Director, and Betuin Garcia, Administrator.

During the investigation, a health and safety inspection of the facility was conducted and residents and staff were interviewed.

It was alleged that the facility constantly serves hot dogs, hamburgers and bread butter and jelly to the residents and that residents don’t have any choices for food. It was further alleged that staff don’t assist residents if they want additional items from the kitchen. Finally, staff were alleged to not follow a resident’s diet plan.

Continued on LIC9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Jesse Gardner	TELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2023

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-20210719092515

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: 03/16/2023

NARRATIVE

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Interviews with residents conducted reveal that the Licensee provides alternative options if the food that is on the menu is not available. LPA further reviewed the menu and found that it offers a variety of choices that conforms to the Food and Nutrition Board for daily diets. Thus, these allegations were Unsubstantiated. A finding of UNSUBSTANTIATED means that 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.

An exit interview was conducted where a copy of this report was discussed with and provided to ????

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Jesse Gardner	TELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2023

LIC9099 (FAS) - (06/04)

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