<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361880793
Report Date: 06/20/2023
Date Signed: 06/20/2023 11:14:46 AM


Document Has Been Signed on 06/20/2023 11:14 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, 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:
06/20/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Tirso Del Junco, Executive DirectorTIME COMPLETED:
11:15 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
Licensing Program Analyst, Amber Coleman, (LPA) arrived at the Sunlit Gardens Assisted Living Facility unannounced to conduct a Case Management visit for Health and Safety. This Case Management visit is in response to a special incident report (SIR) that was received by the Community Care Licensing Office on 6/14/23. LPA introduced self to staff at the front desk and stated purpose of the visit. Staff asked LPA to sign in while the Executive Director was notified. LPA met with Executive Director, Tirso De Junco, introduced self and stated purpose of the visit.

The SIR documents that on 6/11/23 a resident in care left the facility. The family of the resident contacted the facility to ask the whereabouts of the resident. While staff searched for the resident, he was returned by the Police to the facility.

Inquiry into this incident included taking a tour of the facility to assess for any Health and Safety concerns. Interviews with staff, collection and review of pertinent documents. There are no health and safety concerns observed during this visit.

Based on observations and interviews made during today's visit, one (1) deficiency was cited per Title 22, Division 6 of the California Code of Regulations, (CCR) A exit interview was conducted where this report was reviewed discussed and provided to Executive Director.
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Amber ColemanTELEPHONE: 951-248-0338
LICENSING EVALUATOR SIGNATURE:
DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/20/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 06/20/2023 11:14 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507


FACILITY NAME: SUNLIT GARDENS ASSISTED LIVING
FACILITY NUMBER: 361880793

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/20/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/20/2023
Section Cited
CCR
80078(a)

1
2
3
4
5
6
7
80078 Responsibility for Providing Care and Supervision
(a) The licensee shall provide care and supervision as necessary to meet the client's needs.
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Executive Director has implemented a special inservice training for staff who provide care to residents in care with risk of elopement. Staff conducts 30 mins. room checks. Additionally, the facility has committed to running elopement drills on a monthly basis for certain builidings and
8
9
10
11
12
13
14
Based on observations, interviews and review of records, resident succesfully eloped from the facility when facility staff was not able to keep resident within sight. This poses an potential health and safety risk to resident in care.
8
9
10
11
12
13
14
a weekly elopement drill for the remainder of the buildings.
As of today's visit, this POC has been satisfied. The incident report submitted to the Department on 6/14/23 reports elopement drills and room checks had been implemented.

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Amber ColemanTELEPHONE: 951-248-0338
LICENSING EVALUATOR SIGNATURE:
DATE: 06/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/20/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2