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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361881227
Report Date: 10/21/2021
Date Signed: 10/21/2021 03:46:01 PM

Substantiated


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
10/15/2021 and conducted by Evaluator Melody Brown
COMPLAINT CONTROL NUMBER: 18-NP-20211015105858
FACILITY NAME:SUNSHINE BOARD AND CARE IIFACILITY NUMBER:
361881227
ADMINISTRATOR:HAMED, NAJEHFACILITY TYPE:
735
ADDRESS:1203 N. IRIS LANETELEPHONE:
(786) 219-6008
CITY:RIALTOSTATE: ZIP CODE:
92376
CAPACITY:10CENSUS: DATE:
10/21/2021
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Najeh HamedTIME COMPLETED:
03:50 PM
ALLEGATION(S):
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Unlicensed Care is being provided
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Melody Brown and Amy Goldenberg conducted an unannounced visit to initiate a complaint investigation and deliver the findings for the above allegation. LPAs met with operator Najeh Hamed.

Interviews with Resident 1 (R1), Resident 2 (R2) , Resident 3 (R3), Resident 4 (R4), Resident 5 (R5) and Operator Najeh Hamad and Staff 2 (S2) and Staff 3 (S3) confirmed that the all residents requires care and supervision. Operator Najeh Hamad provides R1, R2, R3, R4 and R5 with assistance in medication administration. R1, R2, R3 and R4 arranged medical appointments and transportation by utilizing outside agency. R5 arranged medical appointments and transportation with family member. Based on the evidence gathered during investigation, the above allegation is SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. Health and Safety Code 1508 is being cited on the attached LIC9099D.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021
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 3
Control Number 18-NP-20211015105858
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: SUNSHINE BOARD AND CARE II
FACILITY NUMBER: 361881227
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/21/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/05/2021
Section Cited
HSC
1508
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No person, firm, partnership, association, or corporation within the state and no state or local public agency shall operate, establish, manage, conduct, or maintain a community care facility in this state, without a current valid license therefore as provided in this chapter. This regulation
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The operator will immediately relocate Residents 1 and 5 to a licensed facility that will provide proper care and wait for the license application approval from CDSS. Resident 2, 3 and 4 cannot be provided care and supervision.
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was not met as evidence by: based in interviews, Operator provides R1, R2, R3, R4 and R5 with assistance in medication administration.
This is an immediate health and safety risk to residents in care.
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The operator was informed that penalties will be assessed in the amount of $100 per day per resident retroactively for the 1st 15 days. Thereafter it will be $200 per day until the POC is met.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 18-NP-20211015105858
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: SUNSHINE BOARD AND CARE II
FACILITY NUMBER: 361881227
VISIT DATE: 10/21/2021
NARRATIVE
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Refer to LIC9099D dated 10/21/2021 for deficiencies cited. A civil penalty will be assessed for an amount of $100 per day per resident retroactively for the first 15 days if the operator fails to correct the deficiency on the plan of correction (POC) date. Additionally, the civil penalty will accrue to $200 per day per resident until the POC is met.

LPAs conducted an exit interview where a copy of this report (LIC 9099 and LIC 9099D) and a Notice of Operation in Violation of Law letter was discussed and provided to Operator Najeh Hamed.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3