336425525-7-27-2021-18-AS-KCLS-C5TUUY-20210812155418

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336425525
Report Date: 07/27/2021
Date Signed: 07/27/2021 03:50:23 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
07/23/2021 and conducted by Evaluator Deborah Mullen

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210723165710

FACILITY NAME:	SUNNY ROSE GLEN		FACILITY NUMBER:	336425525
ADMINISTRATOR:	GRISELDA T. GARCIA		FACILITY TYPE:	740
ADDRESS:	29620 BRADLEY RD		TELEPHONE:	(951) 679-3355
CITY:	MENIFEE	STATE: CA	ZIP CODE:	92586
CAPACITY:	81	CENSUS: 51	DATE:	07/27/2021
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Shannon Johnson, Executive Director		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff threatened to evict resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst's (LPA) Deborah Mullen and Jesse Gardner arrived and met with Executive Directive Shannon Johnson. The purpose of this visit was to investigate the above allegation. LPA's interviewed staff and resident (R1).

Ms. Johnson stated R1 has paid a portion of the rent for July 2021 but has a balance outstanding. Ms. Johnson stated R1 is enrolled in the Assisted Living Waiver Program (ALW). Ms. Johnson advised R1 if he failed to pay rent, he could get evicted from the ALW program which would jeopardise the ALW services he is receiving.

R1 was interviewed and stated staff threatened to evict him from the facility if he failed to pay the rent in full. R1 has the understanding that the rent will be covered by the ALW program and his Social Security benefit each month.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Deborah Mullen	TELEPHONE: (951) 212-0616
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2021

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-20210723165710

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: SUNNY ROSE GLEN	FACILITY NUMBER: 336425525
	VISIT DATE: 07/27/2021

NARRATIVE

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LPA's reviewed R1's contracts with the facility and found that R1 signed an Admissions Agreement which details the specific amount of rent R1 is responsible for each month.

Based on the information obtained there is not enough evidence to state staff threatened to evict resident from the facility. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations 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 reviewed with and provided to Ms. Johnson.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Deborah Mullen	TELEPHONE: (951) 212-0616
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2021

LIC9099 (FAS) - (06/04)

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