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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347004408
Report Date: 02/27/2024
Date Signed: 02/27/2024 10:36:50 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/20/2023 and conducted by Evaluator Jamie Ivey-Canady
COMPLAINT CONTROL NUMBER: 27-AS-20231120141425
FACILITY NAME:SUNNY BEACH VILLAFACILITY NUMBER:
347004408
ADMINISTRATOR:DIMITROVA, DESSIFACILITY TYPE:
740
ADDRESS:2506 CASTLEWOOD DRTELEPHONE:
(916) 486-4265
CITY:SACRAMENTOSTATE: CAZIP CODE:
95821
CAPACITY:6CENSUS: 2DATE:
02/27/2024
UNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Dessi DimitrovaTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Licensee financially abused resident in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jamie Ivey Canady arrived unannounced to deliver complaint findings. LPA Ivey Canady met with staff and later with Administrator Dessi Dimitrova. LPA Ivey Canady explained the reason for the visit.

The Department has determined the following as it relates to the complaint allegation: Licensee financially abused resident in care


Cont 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Jamie Ivey-Canady
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024
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 2
Control Number 27-AS-20231120141425
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: SUNNY BEACH VILLA
FACILITY NUMBER: 347004408
VISIT DATE: 02/27/2024
NARRATIVE
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On 2/22/2024 Licensing Program Analyst (LPA) Jamie Ivey Canady investigated current facility allegations. According to interviews with facility staff and residents, credit cards and funds have not been utilized by facility staff after 5/18/2023, the date R1 deceased. Based on facility record review, witness statements and financial institution records, R1 funds have been accessed after 5/18/2023. It was learned from facility residents and staff, that R1 shared a food deliver account with R2. Based on witness record review, there are payments that were accessed from R1 credit account; however those are payments that had been set on an automatic withdrawal and as of date of complaint, R1 estate had not stopped the automatic payments. Based on staff and resident interviews, R1 purchased a meal with the use of a food delivery account one day prior to R1 deceased. According to R1 financial records there are insurance premiums being withdrawn from R1 account. It was learned a life insurance policy was purchased by R1 with the facility administrator named as the beneficiary. However according to facility staff and facility resident statements, R1 was asked not to purchase the insurance policy. Based on facility staff statement and facility records, facility staff administrator has declined the option to file a claim for insurance payout and the insurance account has been closed by R1 insurance company. Therefore, the allegation Licensee financially abused resident in care is Unsubstantiated. An unsubstantiated finding 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.


Per California Code of Regulations (CCRs) - Title 22 no deficiencies cited. Exit interview was held and a copy of report was given to facility administrator
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Jamie Ivey-Canady
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2