361880661-10-16-2019-18-AS-JESL-BL3RAR-20200122115134

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880661
Report Date: 10/16/2019
Date Signed: 10/16/2019 04:02:55 PM

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
10/09/2019 and conducted by Evaluator Crystal Colvin

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20191009154247

FACILITY NAME:	SUNRISE VALLEY INC - KAMANA		FACILITY NUMBER:	361880661
ADMINISTRATOR:	TAMISIN, ABIGAIL N		FACILITY TYPE:	740
ADDRESS:	18752 KAMANA RD		TELEPHONE:	(760) 880-2227
CITY:	APPLE VALLEY	STATE: CA	ZIP CODE:	92307
CAPACITY:	6	CENSUS: 6	DATE:	10/16/2019
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Licensees Abagail Tasimin & Khristine Smith-Tamisin		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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-Facility staff yells at the resident

-Staff failed to meet the residents' needs.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Crystal Colvin and David Cuevas conducted an unannounced visit to the facility to investigate the above allegation. LPAs met with Licensee Abagail Tasimin and Khristine Smith-Tamisinand LPAs explained the purpose of the visit.

Regarding the allegation "Facility staff yells at the resident": On 10/15/19, LPA Colvin interviewed family members for five of the current residents, and asked them about if staff yell at any residents, or if they have had their family member tell them that staff has yelled at them. All family members of the current 5 residents denied hearing any staff members yell at residents or having had their family member at the facility tell them that staff yells at them. On 10/16/19, LPAs Colvin and Cuevas interviewed five out of the six residents currently residing at the facility (one resident was not present). All five of the residents interviewed denied having any staff yell at them, or hearing them yell at other residents. The allegation noted above is deemed to be UNFOUNDED.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal Colvin	TELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:	DATE: 10/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2019

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-20191009154247

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: SUNRISE VALLEY INC - KAMANA	FACILITY NUMBER: 361880661
	VISIT DATE: 10/16/2019

NARRATIVE

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Regarding allegation "Staff failed to meet the residents' needs": LPA Colvin interviewed five current residents' family members on 10/15/19 regarding if their family member at the facility's needs were being met. The family members interviewed for the five residents all indicated that as of 10/15/19, their loved ones needs are being met. LPAs Colvin and Cuevas additionally interviewed five out of six current residents in the facility (one resident was not present) regarding if their needs were being met. All five residents informed LPAs Colvin and Cuevas that their needs were being met, and that staff answers promptly when they signal for something that they need. Neither LPA Colvin nor LPA Cuevas observed any immediate concerns with any of the residents and their needs during the inspection. The allegation noted above is deemed to be UNFOUNDED.

We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.

Exit interview conducted and copy of the report was provided to Licensees Abigail Tamisin and Khristine Smith.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal Colvin	TELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:	DATE: 10/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2019

LIC9099 (FAS) - (06/04)

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