336425525-3-10-2023-18-AS-JESL-CQH39H-20230401180311

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336425525
Report Date: 03/10/2023
Date Signed: 03/10/2023 10:19:09 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
04/14/2022 and conducted by Evaluator Javina George

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20220414122249

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: 49	DATE:	03/10/2023
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Executive Director Diana Salas		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

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Staff not providing adequate care to resident(s).
Resident belongings are not being safeguarded.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to deliver findings for the allegations noted above. LPA met with Administrator Executive Director Diana Salas and discussed the details pertaining to the complaint. In April 2022, the regional office received a complaint with the allegation(s) noted above. The allegations(s) were investigated. The investigation consisted of observation, interview and record review.
Regarding the allegation of staff not providing adequate care to residents.

It was reported and confirmed that Resident #1 (R1) was diagnosed with having both scabies and oral thrush. R1 was prescribed Permethrin cream on 4/6/22, and Nystatin 100,000ML prescribed on 4/13/22. In addition, R1 was receiving services from an outside agency, for the month of April 2022, R1 had visits on 4/2/22, 4/6/22, 4/9/22, 4/11/22 and 4/13/22. The same outside agency provides services that include a physical assessment, including brushing R1’s teeth.
Continued on 9099C*

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2023

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-20220414122249

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: 03/10/2023

NARRATIVE

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Further R1 is also to have a bath aid that is provided by an additional outside agency. As noted, the medication was not prescribed until 4/6/22 and 4/13/22. In addition, per the visit note dated 4/2/22, it was documented that there were not any significant changes with R1 noted on the visit form. With the documentation reviewed, it is unclear if the facility staff are providing adequate care to the residents. Therefore, the allegation of staff not providing adequate care to resident(s) is UNSUBSTANTIATED.

Allegation: Resident belongings are not being safeguarded.

Regarding allegation of resident belongings are not being safeguarded. It was stated during interviews conducted with the acting Administrator Leticia Martinez that staff was unaware R1s glasses were broken and believed that R1 lost their glasses at the beginning of February 2022. Leticia further stated that on February 22, 2022 a message was sent requesting a new pair of glasses to be ordered as well as dentures on 2/25/22. Leticia did state that R1 was sent out to the emergency room on 1/12/2022, for an unwitnessed fall. Leticia stated that the dentures were sent with R1 when they were transported to the hospital and is unsure if the items were sent back with R1 when they returned to the facility.

It is unknown of the whereabouts of R1’s dentures, when R1 had visits with family or friends the glasses were not observed to have been broken, R1 could not recall what happened to their glasses. Due to the lack of evidence the allegation of resident belongings are not being safeguarded is 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 copy of this report was provided to Executive Director Diana Salas.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2023

LIC9099 (FAS) - (06/04)

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