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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361880793
Report Date: 01/10/2023
Date Signed: 01/10/2023 12:26:52 PM


Document Has Been Signed on 01/10/2023 12:26 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
, CA 92507



FACILITY NAME:SUNLIT GARDENS ASSISTED LIVINGFACILITY NUMBER:
361880793
ADMINISTRATOR:STEVENSON, CHERYLFACILITY TYPE:
740
ADDRESS:9428 19TH STREETTELEPHONE:
(909) 481-2600
CITY:ALTA LOMASTATE: CAZIP CODE:
91701
CAPACITY:100CENSUS: 83DATE:
01/10/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:34 AM
MET WITH:Cheryl StevensonTIME COMPLETED:
12:27 PM
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Licensing Program Analyst (LPA) Anna Bueno to discuss an incident report that was received by the Department on 12/6/22. LPA met with administrator Cheryl Stevenson and LPA reviewed records. The following is a summary of the incident:

On 12/4/22, Resident 1 (R1) was being assisted by Staff 1(S1) and Staff 2(S2). S2 witnessed S1 handle R1 roughly and S1 hit R1 with a closed fist on their forehead. It was reported that R1 did not have any injuries or bruising from the incident. S2 reported the incident to administrative and nursing staff. Administrator Stevenson stated that the facility contacted the local police department and S1 was suspended on 12/5/22 while the facility conducted an internal investigation.

Records reviewed during today's visit show that S1 completed disease care and assistance related trainings on 5/31/2022 and preventing, recognizing, and reporting abuse trainings on 5/31/2020. A police report was filed however the facility does not have a copy of the report. S1 did not return to work and was terminated from this facility as of 12/23/22.

No deficiencies were cited during today's visit. An exit interview was conducted where a copy of this report was provided to Ms. Stevenson.
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Anna BuenoTELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:
DATE: 01/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/10/2023
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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