336425525-3-10-2023-18-AS-JESL-CRBW39-20230428165533

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336425525
Report Date: 03/10/2023
Date Signed: 03/10/2023 10:11:39 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
04/25/2022 and conducted by Evaluator Javina George

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20220425171553

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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Resident sustained multiple unwitnessed falls.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to deliver findings for the allegation noted above. LPA met with Executive Director Diana Salas and discussed the details pertaining to the complaint. The allegation of resident sustained multiple unwitnessed falls was investigated. The investigation consisted of observation, interviews and record review.

In April 2022 the regional office received complaint allegation Resident #1 (R1) sustained multiple unwitnessed falls. R1 in fact did sustain a total of three (3) unwitnessed falls on (4/17/22, 4/22/22, and 4/24/22). All three noted unwitnessed falls required for R1 to be sent out to the emergency room. R1 was cleared to return to the facility and was not noted to have any significant injuries outside of hitting their head during the 4/22/22 fall.
A record review revealed that at the time of all three unwitnessed falls there was sufficient staffing with their being one (1) Med Tech and two (2) Caregivers in the memory care unit, during both the AM and PM shifts. The facility had a total of 25 residents in the memory care unit during the time of the incidences noted.

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-20220425171553

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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There is no clear indication that the facility was not providing proper care and supervision during the time of each unwitnessed falls.

At this time, there is no evidence to support that there was inadequate care and supervision therefore the allegation of Resident sustained multiple unwitnessed falls 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 a 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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