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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336425525
Report Date: 07/26/2024
Date Signed: 07/26/2024 11:45:42 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 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
08/14/2023 and conducted by Evaluator Jacqueline Shaw Ross
COMPLAINT CONTROL NUMBER: 18-AS-20230814193729
FACILITY NAME:SUNNY ROSE GLENFACILITY NUMBER:
336425525
ADMINISTRATOR:SHANNON JOHNSONFACILITY TYPE:
740
ADDRESS:29620 BRADLEY RDTELEPHONE:
(951) 679-3355
CITY:MENIFEESTATE: CAZIP CODE:
92586
CAPACITY:81CENSUS: 88DATE:
07/26/2024
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Karen Roper, Executive DirectorTIME COMPLETED:
11:48 AM
ALLEGATION(S):
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Staff did not ensure facility is free of bed bugs.
Staff does not allow resident access to personal items.
Staff administered medication without the resident’s responsible party’s consent.
Facility microwave is in disrepair.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jacqueline Shaw Ross arrived at the facility unannounced to deliver findings on the above allegations. LPA met with Karen Roper, Executive Director, and explained the purpose of the visit.

On August 14, 2023, Community Care Licensing received a complaint that staff did not ensure the facility was free of bed bugs, facility has had multiple incidents of bedbugs. Interviews with residents and staff confirmed there were bedbugs in July and in August of 2022. Staff reported that bedbugs were cleared during that time, however; bedbugs returned a second time in July and August of 2023. Staff reported Resident #1 (R1) was temporarily moved from their assigned room in order for the room to be treated. Information obtained from additional witnesses state bedbugs were observed on multiple occasions, but could not recall dates. Documents reviewed indicate that the facility contracted with Orkin Pest Control and four treatments were conducted at the facility between June and August 2023. Based on records, interviews and observations, the allegation that staff did not ensure the facility is free of bedbugs is UNSUBSTANTIATED at this time.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Jacqueline Shaw RossTELEPHONE: 951-248-0314
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2024
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 7
Control Number 18-AS-20230814193729
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
VISIT DATE: 07/26/2024
NARRATIVE
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Regarding the allegation that staff does not allow (R1) access to their items, it was reported that staff refused to allow R1 to return to their old room to obtain their belongings. Information obtained from staff and additional witness interviews stated that R1 was not permitted to return to their old room to ensure the treatment of the room was complete and success. Under direction of the pest control company, items were bagged and stored. Staff permitted R1 to obtain a few belongings; however, the pest control company advised that none of the items should be returned to R1's new room. Staff reported they sent text messages and images of R1's belongings to R1's family to determine what can be discarded. Staff reported R1's family refused to come to the facility to obtain the items. Additional witnesses stated R1 had a right to obtain their personal belongings once treatment was completed. Based on interviews, observations and document review, this allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation that staff administered medication without R1's responsible party's consent, it was reported that the facility staff was giving R1 medication against their will to keep them asleep. Additional witness was unable to provide any documentation, dates, or additional proof that R1 was being administered medication without RP's consent. Information obtained by staff interviews stated that R1's doctor prescribed medication, but medications were discontinued due to R1's family disagreed of medications prescribed. Based on insufficient information, this allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation that the facility microwave is in disrepair. R1 indicated something was wrong with the borrowed microwave, but could not provide additional details when asked. Staff reported R1 would heat food in the microwave for 20 minutes at a time, which caused the microwave to catch fire. After this incident, it was decided to remove the microwave from R1's room for safety reasons. Staff are now required to warm up R1's food. Information obtained from additional witness indicated they were not aware of any issues with the microwave. Based on interview, observation and document review, this allegation is UNSUBSTANTIATED at this time.

Based on interviews, observations, and documents obtained, the listed allegations are 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 nor did not occur. An exit interview was conducted and a copy of this report was provided to Karen Roper, Executive Director.
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Jacqueline Shaw RossTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 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
08/14/2023 and conducted by Evaluator Jacqueline Shaw Ross
COMPLAINT CONTROL NUMBER: 18-AS-20230814193729

FACILITY NAME:SUNNY ROSE GLENFACILITY NUMBER:
336425525
ADMINISTRATOR:SHANNON JOHNSONFACILITY TYPE:
740
ADDRESS:29620 BRADLEY RDTELEPHONE:
(951) 679-3355
CITY:MENIFEESTATE: CAZIP CODE:
92586
CAPACITY:81CENSUS: 88DATE:
07/26/2024
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Karen Roper, Executive DirectorTIME COMPLETED:
11:48 AM
ALLEGATION(S):
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Staff does not accomodate resident with soft foods.
Facility plumbing is in disrepair.
Facility as mold.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jacqueline Shaw Ross arrived at the facility unannounced to deliver findings on the above allegations. LPA met with Karen Roper, Executive Director, and explained the purpose of the visit.

On August 14, 2023, Community Care Licensing received a complaint that staff does not accomodate resident with soft foods. Information obtained from staff interviews stated that R1 was not prescribed a special diet, but staff accommodated R1 with soft foods because R1 and staff identified R1 had a problem with their teeth. R1's family corroborated that R1 did have a problem with their teeth; however it was fixed. R1's family stated there was never an issue of the facility not providing soft foods to R1. Therefore the allegation that staff does not accomodate resident with soft foods is UNFOUNDED at this time.

It was also alleged that the facility plumbing is in disrepair. It was reported that there was a water leak draining from the air conditioning unit into R1's bathroom. Interviews with staff indicated R1 would stuff tissue into the sink and toilet regularly, causing plumbing problems.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Jacqueline Shaw RossTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2024
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 7
Control Number 18-AS-20230814193729
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
VISIT DATE: 07/26/2024
NARRATIVE
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Information obtained from interview with R1 corroborated the information and stated they purposely clog the toilet with paper. No other areas in the facility were affected outside of R1's room and no other concerns were addressed. Therefore the allegation that the facility plumbing is in disrepair is UNFOUNDED at this time.

Regarding the allegation that the facility has mold, information obtained from additional witness stated there were no concerns of mold advised. Additional witness could not provide any information regarding where the allegation could be derived from. LPA Goodrich observed R1's room and saw no evidence of mold in either Room #6 or Room #10. Information obtained from staff interviews advised that R1 did not have mold in their room. Information obtained from interviews with R1 did not corroborate the allegation. Therefore the allegation that the faciliy has mold is UNFOUNDED at this time.

A finding that the complaint is UNFOUNDED means that the allegation is false, could not have happened, and/or is without a reasonable basis.

A copy of this report was reviewed with and provided to Karen Roper, Executive Director.
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Jacqueline Shaw RossTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 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
08/14/2023 and conducted by Evaluator Jacqueline Shaw Ross
COMPLAINT CONTROL NUMBER: 18-AS-20230814193729

FACILITY NAME:SUNNY ROSE GLENFACILITY NUMBER:
336425525
ADMINISTRATOR:SHANNON JOHNSONFACILITY TYPE:
740
ADDRESS:29620 BRADLEY RDTELEPHONE:
(951) 679-3355
CITY:MENIFEESTATE: CAZIP CODE:
92586
CAPACITY:116CENSUS: 88DATE:
07/26/2024
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Diana Salas, Wellness DirectorTIME COMPLETED:
11:48 AM
ALLEGATION(S):
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Staff does not ensure resident is provided a comfortable temperature.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jacqueline Shaw Ross arrived at the facility unannounced to deliver findings on the above allegations. LPA met with Karen Roper, Executive Director, and explained the purpose of the visit.

On August 14, 2023, Community Care Licensing received a complaint that staff does not ensure the resident is provided a comfortable temperature. Interviews with an additional witness indicated that during a visit, R1's room was 91 degrees. Information obtained from an interview with the AC Dispatcher reported they received six calls stating there was no air conditioning in room #6, where R1 resided in July 2023. It was advised that R1 was relocated to room #10, which was not providing cool air either. The facility dispatcher advised that the air conditioning units are individual and that additional maintenance was completed in September 2023. Staff indicate that the AC units are an ongoing issue, especially during summer.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Jacqueline Shaw RossTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 18-AS-20230814193729
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
VISIT DATE: 07/26/2024
NARRATIVE
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 It was advised that facility staff did not provide reasonable accommodations while the repairs were being done. Based on observations, record review, and interviews conducted, the preponderance of evidence standard has been met, therefore the allegation was found to be SUBSTANTIATED.

A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met.
The facility was cited under California Code of Regulations (Title 22, Division 6, Chapter 8),on the attached LIC9099-D.

An exit interview was conducted were this report, 9099D and appeal rights were provided to Karen Roper, Executive Director.
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Jacqueline Shaw RossTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 18-AS-20230814193729
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 07/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/26/2024
Section Cited
HSC
80088(a)
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Fixtures, Furniture, Equipment and Supplies. Licensee shall maintain temperatures in rooms that clients occupy between a minimum of 68 degrees F (20 degrees C) and a maximum of 85 degrees F (30 degrees C).
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Executive Director states new air conditioners in individual rooms have installed residents rooms since last year and continue to be installed on an as needed basis. LPA Shaw Ross toured R1's room and observed it to be at a
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The temperature in resident’s bedrooms was uncomfortably hot and resident was not provided a cool and comfortable environment. Extreme temperatures can be an immediate health and safety risk to residents in care and in certain instances may have adverse reactions and/or serious side effects to users of certain medications.
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comfortable within regulatory requirments. This issue has been cleared at the time of visit.
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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: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Jacqueline Shaw RossTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2024
LIC9099 (FAS) - (06/04)
Page: 7 of 7