336425525-5-5-2022-18-AS-JGEE-CE5RED-20220505125720

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 336425525
Report Date: 05/04/2022
Date Signed: 05/05/2022 12:58:00 PM

Document Has Been Signed on 05/05/2022 12:58 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

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: 51	DATE:	05/04/2022
TYPE OF VISIT:	Case Management - Other	ANNOUNCED	TIME BEGAN:	09:07 AM
MET WITH:	Robert Lee, President		TIME COMPLETED:	10:04 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 05/04/22 Licensing Program Analyst (LPA) Javina George and Licensing Program Manager (LPM) Joel Esquivel due to time constraints conducted a virtual informal meeting via Microsoft Teams. Also, in attendance was facility President/Financial Advisor Robert Lee, on behalf of the owner Mike Adam. The informal meeting consisted of discussion of the following concerns: Staffing: -A status update was provided due to the Executive Director (Administrator) resigning on 4/8/22 and the vacant position is posted online. The facility will appoint an administrator by 5/30/22. In addition, the facility will seek additional assistance from consultants to provide resources to the new administrator. -Issues and concerns were discussed regarding the attributes to possible staff shortage – although statements made to assure that enough staff were in place; an assessment will be made by 5/30/22 and arrange accordingly. Health and Safety: -The memory care has a possible outbreak of scabies, affecting residents and staff. An assessment will be made as soon as possible to contact the local health department and provide a well ness plan no later than 5/30/22. - In previous visits and complaint allegations submitted, noted the sightings of rats, possible bed bugs and an overall lack of care at the facility. A physical assessment will be made by 5/30/22 to bring the facility to good standings.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 05/04/2022

NARRATIVE

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Admissions:
- Intake process needs to be revamped; residents have been admitted requiring a higher level of care. An assessment will be made to implement preventative measures by 5/30/22.

During this meeting Technical Support Program (TSP) was offered as part of resources to the facility. At this time, the facility chose to not participate in the program but will contact Community Care Licensing at 951-248-2222 as needed.

An exit interview was conducted, and a copy of this report was provided to President Robert Lee via email, as the meeting was conducted virtually. An official request was made for signature was made.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022

LIC809 (FAS) - (06/04)

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