336425525-7-19-2022-18-AS-DMUN-CJF6BL-20220919204008

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336425525
Report Date: 07/19/2022
Date Signed: 07/19/2022 03:35:39 PM

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
07/18/2022 and conducted by Evaluator Stephanie Torres

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20220718123136

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: 52	DATE:	07/19/2022
		UNANNOUNCED	TIME BEGAN:	12:26 PM
MET WITH:	Leticia Martinez, Manager		TIME COMPLETED:	03:40 PM

ALLEGATION(S):

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Staff yelled at resident
Staff dispensed medication to resident that was not prescribed

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Stephanie Torres, conducted an unannounced visit to the facility to initiate the investigation into the above allegations. The LPA met with Manager, Leticia Martinez, and informed her of the purpose of her visit.

Regarding the allegation, "Staff yelled at resident," it was alleged Staff One (S1) yelled at Resident One (R1) on or around July 15, 2022. The LPA toured the facility, conducted staff/resident interviews, reviewed records and took copies of pertinent documentation. S1 was interviewed and denied the allegation. R1 was interviewed and reported the incident did take place. An alleged witness to the incident was interviewed; the witness revealed a verbal altercation did take place on July 14, 2022 in the facility salon, though they did try to tune out the conversation. It was reported R1 initiated the dispute with S1 and they had no knowledge of hearing S1 yell at R1. Therefore, due to a lack of information, this allegation is deemed UNSUBSTANTIATED at this time.

Pertaining to the allegation, "Staff dispensed medication to resident that was not prescribed," it was alleged S1

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Stephanie Torres	TELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2022

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-20220718123136

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: 07/19/2022

NARRATIVE

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dispensed a medication to R1, on July 17, 2022 and July 18, 2022, which was not prescribed. S1 was interviewed and denied the allegation. R1 was interviewed and reported S1 dispensed a small white pill to them on both occasions. A review of R1's medications revealed no pills which matched the description given by the resident. A review of R1's Medication Administration Record (MAR) revealed S1 did dispense medications to R1 on July 17, 2022. No additional information was received to refute or corroborate the validity of the allegation. Therefore, due to insufficient information, this allegation is deemed UNSUBSTANTIATED at this time.

A finding that the complaint is unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

This report was reviewed with Martinez and a copy was provided.

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Stephanie Torres	TELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2022

LIC9099 (FAS) - (06/04)

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