336425525-11-21-2022-18-AS-JESL-CLNVYK-20221130155115

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336425525
Report Date: 11/21/2022
Date Signed: 11/21/2022 11:59:04 AM

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
06/22/2022 and conducted by Evaluator Janira Arreola

COMPLAINT CONTROL NUMBER: 18-AS-20220622085159

FACILITY NAME:	SUNNY ROSE GLEN		FACILITY NUMBER:	336425525
ADMINISTRATOR:	SHANNON JOHNSON		FACILITY TYPE:	740
ADDRESS:	29620 BRADLEY RD		TELEPHONE:	(951) 679-3355
CITY:	MENIFEE	STATE: CA	ZIP CODE:	92586
CAPACITY:	81	CENSUS: 54	DATE:	11/21/2022
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Head Nurse, Crystal Tatum		TIME COMPLETED:	12:10 PM

ALLEGATION(S):

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Staff member sexually assaulted resident while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Janira Arreola, conducted an unannounced visit on 11/21/2022 at 11:30 a.m. to the facility in order to deliver findings on the allegation above. LPA met with Head Nurse, Crystal Tatum who was informed of the purpose of the visit.

On June 22, 2022, the regional office received the allegation of "Staff member sexually assaulted resident while in care." The resident being Resident #1 (R1), and staff being Staff #1 (S1). It was alleged that S1 stuck a finger in R1's rectum while getting a diaper change. The Department investigated the allegation and, in the process, conducted interviews, reviewed facility documents and toured the facility. When interviewed R1 had provided unreliable information, such as, R1 stated having lived at the facility for one day, however, facility admisson records revealed that R1 had lived at the facility for over two years. When asked the current date R1 stated “October 2020", actual date was June 2022.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira Arreola	TELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2022

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-20220622085159

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: 11/21/2022

NARRATIVE

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In addition, according to Staff #3, (S3), R1 had also submitted false accusations that multiple staff at the facility had slept with their spouse; this information was noted as an untrue statement. It was revealed that R1 was showed a photograph of S1 to confirm knowledge of staff; R1 responded by saying “I don’t know who that is.” Menifee Police Department also investigated the incident and were unable to find evidence to support the allegation.

S3 added that R1 is a two-person assist, meaning two staff members are always present when assisting in activities of daily living (ADLs). S3 also stated that opposite gender staff are not allowed to change residents; “they can only assist by holding the resident’s legs and turning bodies.”On the day in question S1 and S2 were present and both denied the allegation. Staff #4 (S4) was interviewed and denied the allegation stating that S1 is a “good” caregiver.

Thus, this allegation was deemed to be 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, and a copy of this report was discussed and provided to Head Nurse, Crystal Tatum.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira Arreola	TELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2022

LIC9099 (FAS) - (06/04)

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