336425525-4-5-2023-18-AS-JDHS-CQRSC4-20230410134452

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336425525
Report Date: 04/05/2023
Date Signed: 04/05/2023 03:06:52 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
03/03/2023 and conducted by Evaluator Stephanie Torres

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20230303153321

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:	04/05/2023
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Diana Salas		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Staff do not provide appropriate care to resident
Staff did not safeguard resident's personal belongings
Staff do not treat resident with respect

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Stephanie Torres, conducted an unannounced visit to the facility to start the investigation into the above allegations. The LPA met with Administrator, Diana Salas, and informed her of the purpose of the visit.

The LPA conducted staff/resident interviews, reviewed records, and took copies of relevant documentation.

Pertaining to the allegation, "Staff do not provide appropriate care to resident," it was alleged facility staff do not provide appropraite care to Resident One (R1) in relation to bathing and medication management. Interviews and records revealed R1 does require assistance from staff with bathing and medication management. R1 was interviewed and declined to provide a statement regarding the matter. Therefore, due to insufficient information, this allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation, "Staff did not safeguard resident's personal belongings," it was alleged R1's personal

Unsubstantiated

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: 04/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023

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-20230303153321

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: 04/05/2023

NARRATIVE

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belongings were being stolen. One interview revealed R1 was missing food items, stored in the resident's personal refrigerator, located in the resident's bedroom. Staff interviewed denied having knowledge of missing food items. In addition, interviews revealed R1 has been known to offer food items to staff members in the facility. Therefore, due to insufficient information, this allegation is deemed UNSUBSTANTIATED at this time.

Pertaining to the allegation, "Staff do not treat resident with respect," it was alleged facility staff make fun of R1. Interviews could not provide detailed information on how facility staff make fun of R1. R1 was interviewed and declined to provide a statement regarding the matter. Therefore, due to insufficient information, this allegation is deemed UNSUBSTANTIATED at this time.

A finding that the complaint is unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove the alleged violations occurred.

This report was reviewed with Salas and a copy was provided.

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Stephanie Torres	TELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023

LIC9099 (FAS) - (06/04)

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