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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336425525
Report Date: 09/21/2021
Date Signed: 09/22/2021 09:43:22 AM



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
01/11/2021 and conducted by Evaluator Javina George
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20210111113858
FACILITY NAME:SUNNY ROSE GLENFACILITY NUMBER:
336425525
ADMINISTRATOR:KAREN ROPERFACILITY TYPE:
740
ADDRESS:29620 BRADLEY RDTELEPHONE:
(951) 679-3355
CITY:MENIFEESTATE: CAZIP CODE:
92586
CAPACITY:81CENSUS: 50DATE:
09/21/2021
UNANNOUNCEDTIME BEGAN:
11:32 AM
MET WITH:Executive Director Shannon Johnson TIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff mishandles residents’ medications while in care.
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 listed above. LPA met with Executive Director Shannon Johnson and explained the purpose of the visit. The allegation was investigated by the department. The investigation consisted of observation, interviews and record reviews.

LPA conducted interviews, which that there were multiple times when staff found medications that were left in resident bedrooms, in beds, on the floor or throughout the facility inside furniture e.g. chairs as well as inside of cups. It was reported that it was hard to distinguish if the pills belonged to the same resident and or multiple resident’s based on the locations in which the pills were found. Reports of several medication errors that were also reported. Med techs are responsible for administering medications to the residents. The LVNs are responsible for administering insulin and can assist with medication administration if needed. Based on observation, interview and record review. The allegation of Staff mishandles residents’ medications while in care Is SUBSTANTIATED.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 6
Control Number 18-AS-20210111113858
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: 09/21/2021
NARRATIVE
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A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met.

An exit interview was conducted and a copy of this report, and appeal rights were provided to Executive Director Shannon Johnson.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2021
LIC9099 (FAS) - (06/04)
Page: 6 of 6
Control Number 18-AS-20210111113858
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/21/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/05/2021
Section Cited
CCR
80075(5)(B)
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80075 Health Related Services
(5) If the client's physician has stated in writing that the client is unable to determine his/her own need for nonprescription PRN medication, but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the client with self-administration, providing all of the following requirements are met: (B) Once ordered by the physician the medication is given according to the physician's directions.
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The licensee agrees to hold a staff in service on medication administration. Proof is to be submitted to the departmemt by 5pm on the due date indicated.
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This requirement is not met as evidenced by: Based on observation, interview and record review the licensee did not ensure that medications were not given according to physician's instructions 1 out of 1 times.
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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: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 6
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
01/11/2021 and conducted by Evaluator Javina George
COMPLAINT CONTROL NUMBER: 18-AS-20210111113858

FACILITY NAME:SUNNY ROSE GLENFACILITY NUMBER:
336425525
ADMINISTRATOR:KAREN ROPERFACILITY TYPE:
740
ADDRESS:29620 BRADLEY RDTELEPHONE:
(951) 679-3355
CITY:MENIFEESTATE: CAZIP CODE:
92586
CAPACITY:81CENSUS: 50DATE:
09/21/2021
UNANNOUNCEDTIME BEGAN:
11:32 AM
MET WITH:Executive Director Shannon JohnsonTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff does not meet the required qualifications
Staff force fed a resident while in care
Staff is not qualified to handle an indwelling urinary catheter
Facility is in disrepair
Residents' are not treated with dignity and respect
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(s) listed above. LPA met with Executive Director Shannon Johnson and explained the purpose of the visit. The allegation was investigated by the department. The investigation consisted of observation, interviews and record reviews.

Allegation: Staff does not meet the required qualifications
LPA reviewed staff files with an emphasis on training received for various positions: Care staff/Caregiver, Med Tech, LVN, housekeeper, and dietary staff. LPA observed that all staff files reviewed, revealed the staff received the necessary training that consists of viewing videos, in person and shadowing/hands on training required to successfully perform the tasks associated with the position that is appointed. There was not sufficient evidence to support the allegation, therefore it is UNSUBSTANTIATED.

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 18-AS-20210111113858
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: 09/21/2021
NARRATIVE
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Allegation: Staff force fed a resident while in care.
Interviews were conducted and information provided was that on at least one occasion where management received a report there was a resident that was allegedly force-fed. Management investigated the complaint and there was no proof that a resident was force fed. The facility has camera's throughout Assisted Living and Memory care. A review of video was conducted and nothing was observed and could be confirmed. Note that the facility currently has 3 identified residents that require assistance with feeding that reside in the memory care unit. Interviews were unsuccessful. The allegation of Staff force fed a resident while in care is UNSUBSTANTIATED.

Allegation: Staff is not qualified to handle an indwelling urinary catheter
Through conducted interview which revealed that staff did not feel that they were adequately trained to perform their job duties as they were shown how to perform the task as emptying a catheter one time and then left on their own to perform the task independently. Per Executive Director staff can request additional support or training if needed. Upon review of facility descriptions and interviews the LVNs are solely responsible for catheter care in between home health or hospice visits if needed. Home Health or hospice staff are responsible for changing, or inserting catheters. There was not sufficient evidence to support the allegation, therefore it is UNSUBSTANTIATED.

Allegation: Facility is in disrepair
Facility is in disrepair multiple sources confirm that the time clock does not operate properly when using the preferred method of the Ipad, per Executive Director it is due to the spotty internet. The issues reportedly used to happen more often than it should and results in issues with staff’s paychecks. Such as hours missing, not getting their full pay and not being available on time. In addition should a staff need to be paid for additional hours, the Business Office Manager is able to print the check at the time of discovery.

As of February 2021, the staff have two backup options where they can download an app, Tsheets, to clock in and out that way, as well as a folder on the front desk to record time clock punches that were not successful. Staff are also given reminders the Friday before to get any missed punches via the Crew app.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 18-AS-20210111113858
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: 09/21/2021
NARRATIVE
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Additionally, It was also reported that there was an issue with flooding in memory care specifically in the kitchen. LPA interviewed Maintenance staff whom stated that the fire Marshall recommended to have the pipe replaced. The job was originally expected to take 3 hours, however there was an additional pipe that needed to be replaced. Per Administrator all residents had their showers prior to the water being turned off and the restrooms could be used just not flushed temporarily. The pipe was resolved the same day. There was bottled water available to drink, as well as water from the Sparklett's cooler. The allegation of Facility is in disrepair is UNSUBSTANTIATED.


Allegation: Residents' are not treated with dignity and respect.

It was reported that the resident’s in memory care are being treated differently by staff. There are some staff that yell, and have even shoved a resident. LPA conducted interviews and residents stated that they were happy with their stay at the facility, with no issues to report of being mistreated in both Memory care or Assisted Living. Executive Director and Business Office Manger were not aware of any reports of resident's being mistreated, as the accusation would have been investigated. There was not enough evidence to support the allegation. Therefore it is UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means 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, therefore the allegation is unsubstantiated at this time.




An exit interview was conducted and a copy of this report was provided to Administrator Shannon Johnson.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 6