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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336425525
Report Date: 03/27/2024
Date Signed: 03/27/2024 12:02:18 PM


Document Has Been Signed on 03/27/2024 12:02 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:SUNNY ROSE GLENFACILITY NUMBER:
336425525
ADMINISTRATOR:SALAS, DIANAFACILITY TYPE:
740
ADDRESS:29620 BRADLEY RDTELEPHONE:
(951) 679-3355
CITY:MENIFEESTATE: CAZIP CODE:
92586
CAPACITY:81CENSUS: 69DATE:
03/27/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Karen Roper - Executive DirectorTIME COMPLETED:
12:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced for the purpose of conducting an inspection. LPA Colvin met with Executive Director Karen Roper and explained the purpose of the inspection. While at the facility, LPA Colvin observed that three staff members present (S1, S2, & S3) were not associated to the facility. LPA Colvin confirmed through file review that all three staff have criminal background clearance, but this has not been transferred to the facility in order to associate them. LPA Colvin contacted the Riverside Regional Office to verify if any associations Deficiency cited. When there is a violation of criminal background clearance (such as staff not being associated), a civil penalty is assessed in the amount of $100 per day, per staff member, with a limit of $500 per staff member being assessed, unless the facility has repeated this violation in the last 12 months.

S1 has worked at the facility since January 2024, so LPA Colvin will be assessing $500 in civil penalties for S1 ($100 a day x 5). S2 has worked at the facility since December 2023, so LPA Colvin will be assessing $500 in civil penalties for S1 ($100 a day x 5). S3 has worked at the facility since 3/16/24, so LPA Colvin will be assessing $500 in civil penalties for S1 ($100 a day x 5). Total amount of civil penalties assessed today is $1,500.

An exit interview was conducted with Executive Director Karen Roper and a copy of this report, LIC809D, LIC421BG, LIC9098 Proof of Corrections, and appeal rights was provided.
SUPERVISOR'S NAME: Tricia DanielsonTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Crystal ColvinTELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:
DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/27/2024 12:02 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507


FACILITY NAME: SUNNY ROSE GLEN
FACILITY NUMBER: 336425525

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/27/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/28/2024
Section Cited
CCR
87355(e)(2)

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Criminal Record Clearance: (e) All individuals...shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c)... This requirement was not met by:
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Executive Director states that she will have corporate request the transfer for S1, S2, & S3 immediately. Executive Director will self-certify to LPA Colvin once the transfer is complete, using the LIC9098 form. Self-certification due by Plan of Correction date of 3/28/24.
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Based on record review and observations, the Licensee did not comply with the above regulation with 3 staff members. LPA Colvin observed that S1, S2, & S3 are working in the facility but have not had their background clearance transferred to the facility. This is an immediate safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Tricia DanielsonTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Crystal ColvinTELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:
DATE: 03/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2024
LIC809 (FAS) - (06/04)
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